Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder
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ESEARCH ARTICLE
Open Access
Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review Gian Loreto D’Alò1, Franco De Crescenzo1,2,3* , Laura Amato1, Fabio Cruciani1, Marina Davoli1, Francesca Fulceri4, Silvia Minozzi1, Zuzana Mitrova1, Gian Paolo Morgano5, Franco Nardocci4, Rosella Saulle1, Holger Jens Schünemann5,6, Maria Luisa Scattoni4 on behalf of the ISACA guideline working group
Abstract Background: It is unclear whether the administration of antipsychotics to children and adolescents with autism spectrum disorders (ASD) is acceptable, equitable, and feasible. Methods: We performed a systematic review to support a multidisciplinary panel in formulating a recommendation on antipsychotics, for the development of the Italian national guidelines for the management of ASD. A comprehensive search strategy was performed to find data related to intervention acceptability, health equity, and implementation feasibility. We used quantitative data from randomized controlled trials to perform a meta-analysis assessing the acceptability and tolerability of antipsychotics, and we estimated the certainty of the effect according to the GRADE approach. We extracted data from systematic reviews, primary studies, and grey literature, and we assessed the risk of bias and methodological quality of the published studies. Results: Antipsychotics were acceptable (dropouts due to any cause: RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (dropouts due to adverse events: RR 0.99, 95% CI 0.55–1.79, low certainty of evidence) by children and adolescents with ASD. Parents and clinicians did not raise significant issues concerning acceptability. We did not find studies reporting evidence of reduced equity for antipsychotics in disadvantaged subgroups of children and adolescents with ASD. Workloads, cost barriers, and inadequate monitoring of metabolic adverse events were indirect evidence of concerns for feasibility. Conclusion: Antipsychotics in children and adolescents with ASD were likely acceptable and possibly feasible. We did not find evidence of concern for equity. Keywords: Autism Spectrum disorder, Antipsychotic agents, Systematic review, Guideline, GRADE approach
* Correspondence: [email protected] Istituto Superiore di Sanità Autism Spectrum Disorder in Children and Adolescent guideline working group (ISACA guideline working group). Participants to the ISACA guideline working group are listed in the acknowledgments section. 1 Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00154 Rome, Italy 2 Department of Psychiatry, University of Oxford, Oxford, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropr
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