Fallah Merrick S, Shaikh Mateen R, Neupane Binod, Rusiecki Daniel, Bennett Teresa A, Beyene Joseph
1 Faculty of Medicine, University of Toronto, Toronto, Canada.
2 Faculty of Science, Thompson Rivers University, Kamloops, Canada.
J Child Adolesc Psychopharmacol. 2019 Apr;29(3):168-180. doi: 10.1089/cap.2018.0115. Epub 2019 Feb 1.
Irritability is common in pediatric autism spectrum disorder (ASD) patients. This can have major implications in child development, receptivity to behavioral therapy, as well as child and caregiver well-being. A systematic review and network meta-analysis were conducted to assess the efficacy and safety of atypical antipsychotics in treating irritability in these patients.
Studies were identified from Medline, Embase, and PsycINFO from inception to March 2018. The clinical trials database was reviewed. Studies were included if they were a double-blind, randomized controlled trial utilizing the Aberrant Behavior Checklist Irritability (ABC-I) to measure the efficacy of atypical antipsychotic monotherapy. Data extraction was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses for network meta-analysis guidelines. The main outcome was the reduction in irritability score using the ABC-I subscale from baseline.
Eight trials comparing four interventions-risperidone, aripiprazole, lurasidone, and placebo in 878 patients, were included. Both risperidone and aripiprazole had significantly reduced ABC-I scores than placebo. Estimates of mean differences (95% credible intervals) were risperidone, -6.89 (-11.14, -2.54); aripiprazole, -6.62 (-10.88, -2.22); and lurasidone, -1.61 (-9.50, 6.23). Both risperidone and aripiprazole had similar safety. There were only eight studies included in the analysis, however, sample sizes were not small. Variance in reporting of adverse effects limited the quality of safety analysis.
Risperidone and aripiprazole were the two best drugs, with comparable efficacy and safety in pediatric ASD patients. These two medications could be beneficial in improving irritability in these patients.
易激惹在儿童自闭症谱系障碍（ASD）患者中很常见。这可能对儿童发育、行为治疗的接受度以及儿童和照顾者的幸福感产生重大影响。进行了一项系统评价和网状Meta分析，以评估非典型抗精神病药物治疗这些患者易激惹症状的疗效和安全性。
从创刊至2018年3月，在Medline、Embase和PsycINFO中检索相关研究。对临床试验数据库进行了审查。纳入的研究需为采用异常行为检查表易激惹分量表（ABC-I）来测量非典型抗精神病药物单药治疗疗效的双盲随机对照试验。按照系统评价和网状Meta分析的首选报告项目指南进行数据提取。主要结局是使用ABC-I分量表从基线开始的易激惹评分降低情况。
纳入了八项试验，比较了利培酮、阿立哌唑、鲁拉西酮和安慰剂这四种干预措施，共878例患者。利培酮和阿立哌唑降低ABC-I评分的幅度均显著大于安慰剂。平均差异（95%可信区间）的估计值为：利培酮，-6.89（-11.14，-2.54）；阿立哌唑，-6.62（-10.88，-2.22）；鲁拉西酮，-1.61（-9.50，6.23）。利培酮和阿立哌唑的安全性相似。然而，分析中仅纳入了八项研究，样本量不算小。不良反应报告的差异限制了安全性分析的质量。
利培酮和阿立哌唑是治疗儿童ASD患者易激惹症状的两种最佳药物，疗效和安全性相当。这两种药物可能有助于改善这些患者的易激惹症状。
