Risperidone for autism spectrum disorder

 

Abstract

Background

Autistic spectrum disorder encompasses a wide variety of behavioural and communicative problems. Both the core features and non-core features of autism have been targeted in a variety of therapies. Atypical antipsychotic medications, including risperidone, have been used for symptom and behaviour improvement and have shown beneficial outcomes, particularly in certain aspects of the disorder. However, given the nature of the condition presenting in young patients, the risks of these potentially long term therapies must be weighed against the benefits.

Objectives

To determine the efficacy and safety of risperidone for people with autism spectrum disorder.

Search methods

Electronic databases: CENTRAL (Cochrane Central Register of Controlled Trials) 2006 (Issue 3); MEDLINE (1966 to April 2006); EMBASE (1980 to April 2006); PsycINFO (1887 to April 2006); CINAHL (1982 to April 2006); LILACS (1982 to April 2006 ); Clinicaltrials.gov (USA) (accessed April 2006); ZETOC (1993 to April 2006); National Research Register (NRR) (UK) 2006 (Issue 1) were searched. In addition further data were retrieved through contact with pharmaceutical companies and authors of published trials.

Selection criteria

All randomised controlled trials of risperidone versus placebo for patients with a diagnosis of autism spectrum disorder. All trials had to have at least one standardised outcome measure used for both intervention and control group.

Data collection and analysis

Data were independently evaluated and analysed by the reviewers. Data were evaluated at the end of each randomised controlled trial. Unpublished data were also considered and analysed.

Main results

Only three randomised controlled trials were identified. Meta-analysis was possible for three outcomes. Some evidence of the benefits of risperidone in irritability, repetition and social withdrawal were apparent. These must however be considered against the adverse effects, the most prominent being weight gain.

Authors' conclusions

Risperidone can be beneficial in some features of autism. However there are limited data available from studies with small sample sizes. In addition, there lacks a single standardised outcome measure allowing adequate comparison of studies, and long-term followup is also lacking. Further research is necessary to determine the efficacy pf risperidone in clinical practice.

 

Plain language summary

Risperidone for autism spectrum disorder

Risperidone is an antipsychotic medication that has been used for symptom relief and behavioural improvement in autism. This review encompasses three randomised controlled trials and concludes that risperidone may be beneficial for various aspects of autism including irritability, repetition and hyperactivity. However, all studies were relatively small and used different ways to assess effectiveness, making comparisons difficult. In addition, side effects were identified, notably weight gain. Further studies are therefore necessary to determine the long term benefits, if any, compared with the potential risks.

 

摘要

背景

使用Risperidone於自閉症類疾病患者

自閉症類的疾病包含了相當多種類的行為和溝通問題。針對其核心與非核心特徵，有各式的治療方法。非典型抗精神病藥物，包括risperidone，被使用來改進症狀與行為的問題，並顯示出有益的結果，特別在疾病的某些層面上。然而，考慮到這類疾病在年輕的病人表現上的本質，這些潛在長期治療，其危險性必須與其益處兩相衡量。

目標

評估對於自閉症類疾病，risperidone的效果和安全性。

搜尋策略

搜尋以下電子資料庫，包括：CENTRAL (Cochrane Central Register of Controlled Trials) 2006年 (Issue 3); MEDLINE (1966年 to 2006年4月); EMBASE (1980年 to 2006年4月); PsycINFO (1887年 to 2006年4月); CINAHL (1982年 to 2006年4月); LILACS (1982年 to 2006年4月); Clinicaltrials.gov (USA) (accessed 2006年4月); ZETOC (1993年 to 2006年4月); National Research Register (NRR) (UK) 2006年 (Issue 1) 。除此之外，藉由聯絡藥廠和已發表的試驗之作者，以得到進一步的資料。

選擇標準

對於診斷為自閉症類的病人，比較接受risperidone，與接受安慰劑的隨機控制試驗。所有的試驗，無論是介入組或控制組病人，都需要有至少一個標準化的結果量測。

資料收集與分析

資料被回顧者獨立評估與分析。在每個隨機對照試驗的最後，資料均被評估。未被公開發表的資料也被考慮與分析。

主要結論

只有找到3個隨機控制試驗。統合分析 (metaanalysis) 使用在3個結果上是可能的。某些證據顯示出risperidone在煩躁、重複性行為和社交退縮方面的助益。這些結論應該在考慮副作用，特別是體重增加，之後再做考量。

作者結論

Risperidone對自閉症的某些特徵是有益處的。然而，這些小群體數的試驗提供了侷限的資料。除此之外，缺乏單一的標準化結果量測，使試驗間無法比較，而長期後續追蹤的資料亦缺乏。決定risperidone在臨床實務的效果之進一步研究是必須的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

risperidone為常用的抗精神病藥物，被用於自閉症的症狀和行為改善。這篇回顧包括三篇隨機對照試驗，結論顯示，risperidone對於自閉症的各方面，包括激躁，反覆性和過度活動有益處。然而，所有的試驗相對小型，而且評估有效性的方法不同，使比較有困難。除此之外，也注意到副作用部分，特別是體重增加。因此，需要進一步試驗，以決定長期益處，及比較其潛在的危險。