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SPECTRUM: AUTISM RESEARCH NEWS




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NEWS


SPECTRUM REPORTING PROMPTS NEW REVIEW OF COMMON DRUG

BY JACLYN JEFFREY-WILENSKY  /  29 JANUARY 2021

TOPICS:

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Knowledge gap: Aripiprazole improves irritability in autistic children, but
researchers haven’t explored how age and sex may alter its effectiveness.

PM Images / Getty Images

Listen to this story:

Spectrum reporting prompts new review of common drug
by Jaclyn Jeffrey-Wilensky

00:00

03:43




Aripiprazole, a commonly used antipsychotic medication marketed as Abilify,
curtails aggressive behavior in autistic children, according to a new review,
but not enough is known about the drug’s side effects or its efficacy in
different populations.

A feature in Spectrum last year prompted the new review, says Alan Poling, lead
investigator and professor of psychology at Western Michigan University in
Kalamazoo.

“The Spectrum article caused us to ask ourselves: Did we miss something?” he
says. “That focused our attention on the literature.”

Poling and his colleagues scoured PubMed, Scopus and Web of Science for articles
containing the terms ‘aripiprazole’ and ‘autism spectrum disorder.’ They
winnowed the 500-plus results down to a list of 12 review articles and 14
original studies. None suggested that aripiprazole changes core autism features,
such as social-communication difficulties or restricted and repetitive
behaviors.

Autistic children and teenagers taking aripiprazole improved more than those
taking a placebo, according to a parent-report questionnaire that measures
self-injury, tantrums and other challenging behaviors, the studies found. But
these children also experienced a broad range of side effects, including weight
gain, muscle spasms, tremors and restlessness. The review was published in
January in Advances in Neurodevelopmental Disorders.


UNDERSTUDIED EFFECTS:

The Food and Drug Administration (FDA) approved aripiprazole to treat
irritability associated with autism in 2009, and at least initially its makers
touted it as safer than risperidone, the only other medication approved for use
in autistic children. But as Spectrum’s 2020 coverage revealed, aripiprazole
causes just as much weight gain as risperidone does and, like risperidone, can
cause tardive dyskinesia — involuntary muscle spasms linked to long-term use of
antipsychotics.

Adverse events related to aripiprazole use
The most common adverse events reported in autistic children who took
aripiprazole, according to data collected by the U.S. Food and Drug
Administration. The agency does not verify these reports, and many other adverse
events may go unreported.


Self-injurySleep problemsAtypical behaviorMood problemsAnxietyBehavior
problemsMental impairmentDystoniasTremorHeadacheNeurologicalproblemsChanges
inconsciousnessMovementconditionsMuscle-relatedproblemsMusculoskeletalconditionsAtypical
muscletoneOtherhyperglycemicconditionsDiabetesAppetite conditionsWeight
gainFatigueGastrointestinalproblemsNausea
andvomitingPsychiatricPsychiatricNeurologicalNeurologicalMusculoskeletalMusculoskeletalMetabolicMetabolicGeneralGeneralGastrointestinalGastrointestinal

The most common adverse events reported in autistic children who took
aripiprazole, according to data collected by the U.S. Food and Drug
Administration. The agency does not verify these reports, and many other adverse
events may go unreported. Category Term Count Gastrointestinal Gastrointestinal
problems 11 Gastrointestinal Nausea and vomiting 20 General Fatigue 21 Metabolic
Appetite conditions 18 Metabolic Diabetes 14 Metabolic Other hyperglycemic
conditions 10 Metabolic Weight gain 44 Musculoskeletal Atypical muscle tone 7
Musculoskeletal Muscle-related problems 6 Musculoskeletal Musculoskeletal
conditions 7 Neurological Changes in consciousness 25 Neurological Dystonias 7
Neurological Headache 11 Neurological Mental impairment 7 Neurological Movement
conditions 35 Neurological Neurological problems 15 Neurological Tremor 8
Psychiatric Anxiety 24 Psychiatric Atypical behavior 18 Psychiatric Behavior
problems 33 Psychiatric Mood problems 24 Psychiatric Self-injury 12 Psychiatric
Sleep problems 14

Source: U.S. Food and Drug Administration. Analysis by Jaclyn Jeffrey-Wilensky.
Graphic by Krista Fuentes.





The authors of the new review didn’t find any studies that examined the effects
of aripiprazole in combination with other drugs, even though polypharmacy is
common among autistic people. Nor did they find any studies that explored how
age or sex might influence the drug’s effectiveness, or how that compares with
non-drug therapies. In particular, the researchers found scant evidence of the
drug’s effectiveness in autistic adults.

Nearly all studies of aripiprazole rely on the Aberrant Behavior Checklist, but
this measure cannot give a detailed picture of the drug’s effects, the
researchers say. For example, a decreased score on the questionnaire doesn’t
indicate whether a child’s irritable behaviors have decreased in frequency,
intensity or both. The measure can also fail to differentiate between
improvements in aggressive behavior and more global behavioral effects, such as
sedation.

“There was really no detailed analysis of what the drug’s doing to the behavior
of the people who receive it,” Poling says. “[The Aberrant Behavior Checklist]
is a good rough and ready instrument, easy to use, but it’s really imprecise.”

To fill in these gaps, scientists will need to measure changes in specific
behaviors over longer time frames in autistic people taking aripiprazole, the
researchers say. And in the meantime, clinicians should carefully monitor
children taking aripiprazole for side effects.

“You have to determine whether the trip justifies the fare,” Poling says.

SYNDICATION

This article was republished in The Scientist.

--------------------------------------------------------------------------------

TAGS:   aggression, aripiprazole, autism, data visualizations, spoken version

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