Graduate Program of Psychiatry and Behavioral Sciences, Department of Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
J Psychopharmacol. 2024 Apr;38(4):324-343. doi: 10.1177/02698811241241384. Epub 2024 Apr 4.
Patients with autism spectrum disorder (ASD) may experience severe psychiatric symptoms, often unresponsive to conventional pharmacological therapies, highlighting the need for more effective alternatives.
This study aims to map and synthesize evidence on the use of clozapine as a therapeutic option for managing severe psychiatric symptomatology co-occurring with ASD.
We conducted a scoping review on multiple sources following the JBI guidelines. The search strategy was inclusive, targeting both peer-reviewed publications and gray literature presenting empirical data on the use of clozapine therapy for patients with ASD accompanied by comorbid psychiatric symptoms. Two independent evaluators performed the selection of studies, data extraction, and critical appraisal.
The review included 46 studies, encompassing 122 ASD individuals who received clozapine therapy. The sources of evidence comprise 31 case reports, 8 case series, 6 retrospective observational studies, and 1 quasi-experimental prospective study. The tables present the findings along with a narrative summary. Clozapine treatment demonstrated benefits in four groups of severe and treatment-resistant psychiatric symptoms in ASD patients: disruptive behaviors, psychotic symptoms, catatonia, and mood symptoms. Although side effects were common, tolerability was generally satisfactory. However, severe adverse events, such as seizures, moderate neutropenia, and myocarditis, underscore the need for intensive clinical monitoring.
While clozapine shows promise as a pharmacological intervention for severe psychopathologies in ASD, more rigorous clinical studies are required to elucidate its efficacy and safety in this population. The limited robustness of the evidence calls for caution, signaling an early research stage into this topic.
自闭症谱系障碍（ASD）患者可能会出现严重的精神症状，通常对常规药物治疗反应不佳，这凸显了需要更有效的替代方法。
本研究旨在绘制并综合有关氯氮平作为治疗 ASD 患者共患严重精神症状的治疗选择的证据。
我们按照 JBI 指南在多个来源上进行了范围综述。搜索策略具有包容性，针对同行评议出版物和呈现氯氮平治疗 ASD 伴有共患精神症状患者的经验数据的灰色文献。两名独立评估员进行了研究选择、数据提取和批判性评价。
综述纳入了 46 项研究，共纳入 122 名接受氯氮平治疗的 ASD 个体。证据来源包括 31 份病例报告、8 份病例系列、6 份回顾性观察研究和 1 份准实验前瞻性研究。表格呈现了研究结果，并附有叙述性总结。氯氮平治疗在 ASD 患者的四组严重和治疗抵抗的精神症状中显示出益处：破坏性行为、精神病症状、紧张症和情绪症状。尽管副作用常见，但耐受性通常令人满意。然而，严重的不良反应，如癫痫发作、中度中性粒细胞减少症和心肌炎，强调需要进行密集的临床监测。
虽然氯氮平作为 ASD 严重精神病理的药物干预措施具有潜力，但需要更严格的临床研究来阐明其在该人群中的疗效和安全性。证据的稳健性有限，需要谨慎对待，表明这是该主题的早期研究阶段。
