Risperidone or aripiprazole in children and adolescents with autism and/or intellectual disability: A Bayesian meta-analysis of efficacy and secondary effects

Second-generation antipsychotics (SGAs) induce frequent adverse effects in children and adolescents with each compound appearing to have a specific adverse effect profile. Aripiprazole and risperidone are FDA-approved medications for behavioral disturbances associated with autism and/or intellectual disabilities (ID) in children and adolescents. Using Bayesian meta-analysis of all relevant studies (N = 8; 18 arms: 782 patients), we aimed to calculate odds ratios (OR) or mean average effects to assess efficacy, weight gain, metabolic changes, sedation, and extra-pyramidal syndrome (EPS) of the two compounds. Reporting was incomplete to assess metabolic changes. Compared to placebo, significant treatment-related increases were observed for: CGI response with aripiprazole (OR = 6.09.95% credible interval [2.3-12.63]) and risperidone (12.8 [5.57-27.33]); weight gain with aripiprazole (OR = 6.28[1.64-17.12]) and risperidone (7.76[1.88-25.2]); EPS with risperidone (OR = 3.72 [1.73-7.22]); and somnolence/sedation with aripiprazole (OR = 25.76 [1.29-112.3]) and risperidone (9.63 [3.52-22.79]). There were no significant differences between active compounds. We conclude that short term efficacy of risperidone and aripiprazole are similar for behavioral disturbances associated with autism and/or ID, and that secondary effects are frequent. More research should be conducted on metabolic changes as current literature is lacking compared to other indications in youths. (C) 2012 Elsevier Ltd. All rights reserved.