Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review

Table 1 Summary of Findings for the comparison antipsychotics versus no antipsychotics: quantitative outcomes for acceptability

Antipsychotics versus no Antipsychotics for children and adolescents with ASD
Patient or Population: children and adolescents with ASD Setting: Inpatients and Outpatients Intervention: Antipsychotics Control: no Antipsychotics
Outcomes	Anticipated absolute effects^a (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Outcomes	Risk with no Antipsychotics	Risk with Antipsychotics	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Discontinuation due to any cause (Follow up: median 8 weeks)	244 per 1.000	149 per 1.000 (117 to 190)	RR 0.61 (0.48 to 0.78)	1124 (15 RCT) ^{[33,34,35,36,37,38,39,40,41,42,43,44,45,46,47]}	⨁⨁⨁◯ MODERATE ^b	Antipsychotics probably reduce the risk of dropout due to any cause
Discontinuation due to adverse events (Follow up: median 8 weeks)	39 per 1.000	39 per 1.000 (22 to 70)	RR 0.99 (0.55 to 1.79)	1010 (12 RCT) ^{[34,35,36,37,38,39,40,41,42,43,44,45,46,47]}	⨁⨁◯◯ LOW ^a,b	Antipsychotics may result in little to no difference in the risk of dropout due to adverse events

^aThe risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI Confidence interval, SMD Standardised mean difference, RR Risk ratio
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
Explanations
a. Downgraded by one level because the 95%CI for SMD goes from considerable beneficial effects to undesirable effects
b. Downgraded by one level because most studies showed an unclear risk for selection bias, four studies were at high risk for attrition bias, one study was at high risk for selection bias and one study was at high risk for reporting bias
References [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47]

ISSN: 1471-244X