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Pharmacological and non-pharmacological interventions for irritability in autism spectrum disorder: a systematic review and meta-analysis with the GRADE assessment

Authors
 Hangnyoung Choi  ;  Jae Han Kim  ;  Hee Sang Yang  ;  Jong Yeob Kim  ;  Samuele Cortese  ;  Lee Smith  ;  Ai Koyanagi  ;  Elena Dragioti  ;  Joaquim Radua  ;  Paolo Fusar-Poli  ;  Jae Il Shin  ;  Keun-Ah Cheon  ;  Marco Solmi 
Citation
 MOLECULAR AUTISM, Vol.15(1) : 1-14, 2024-01 
Journal Title
MOLECULAR AUTISM
Issue Date
2024-01
MeSH
Aripiprazole ; Autism Spectrum Disorder* ; Female ; GRADE Approach* ; Humans ; Male ; Risperidone
Keywords
Autism spectrum disorder ; Irritability ; Meta-analysis ; Randomized controlled trial ; Systematic review
Abstract
BackgroundNumerous interventions for irritability in autism spectrum disorder (ASD) have been investigated. We aimed to appraise the magnitude of pharmacological and non-pharmacological interventions for irritability in ASD without any restrictions in terms of eligible interventions.MethodsWe systematically searched PubMed/MEDLINE, Scopus, and Web of Science until April 15, 2023. We included randomized controlled trials (RCTs) with a parallel design that examined the efficacy of interventions for the treatment of irritability in patients of any age with ASD without any restrictions in terms of eligible interventions. We performed a random-effects meta-analysis by pooling effect sizes as Hedges' g. We classified assessed interventions as follows: pharmacological monotherapy, risperidone plus adjuvant therapy versus risperidone monotherapy, non-pharmacological intervention, and dietary intervention. We utilized the Cochrane tool to evaluate the risk of bias in each study and the GRADE approach to assess the certainty of evidence for each meta-analyzed intervention.ResultsOut of 5640 references, we identified 60 eligible articles with 45 different kinds of interventions, including 3531 participants, of which 80.9% were males (mean age [SD] = 8.79 [3.85]). For pharmacological monotherapy, risperidone (Hedges' g - 0.857, 95% CI - 1.263 to - 0.451, certainty of evidence: high) and aripiprazole (Hedges' g - 0.559, 95% CI - 0.767 to - 0.351, certainty of evidence: high) outperformed placebo. Among the non-pharmacological interventions, parent training (Hedges' g - 0.893, 95% CI - 1.184 to - 0.602, certainty of evidence: moderate) showed a significant result. None of the meta-analyzed interventions yielded significant effects among risperidone + adjuvant therapy and dietary supplementation. However, several novel molecules in augmentation to risperidone outperformed risperidone monotherapy, yet from one RCT each.LimitationsFirst, various tools have been utilized to measure the irritability in ASD, which may contribute to the heterogeneity of the outcomes. Second, meta-analyses for each intervention included only a small number of studies and participants.ConclusionsOnly risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings.Trial registration PROSPERO, CRD42021243965.ConclusionsOnly risperidone, aripiprazole among pharmacological interventions, and parent training among non-pharmacological interventions can be recommended for irritability in ASD. As an augmentation to risperidone, several novel treatments show promising effects, but further RCTs are needed to replicate findings.Trial registration PROSPERO, CRD42021243965.
Files in This Item:
T202401323.pdf Download
DOI
10.1186/s13229-024-00585-6 RESEARCH
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Cheon, Keun Ah(천근아) ORCID logo https://orcid.org/0000-0001-7113-9286
Choi, Hangnyoung(최항녕)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198685
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