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首页> 外文期刊>Journal of the Canadian Academy of Child and Adolescent Psychiatry >Review of the Pharmacotherapy of Irritability of Autism
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Review of the Pharmacotherapy of Irritability of Autism

机译：自闭症易激惹药物疗法的评论

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Objective: To review the randomized controlled trial data regarding pharmacotherapy of irritability of autism. Method: A literature review was conducted using the MEDLine search terms: ‘autism’ OR ‘autism spectrum disorder’ with the following limits: Randomized Controlled Trials (RCTs), human trials, English language. Additional articles were identified from reference information. Trials involving nutritional supplements, hormones or drugs not approved by either Health Canada or the US Food and Drug Administration (FDA) were excluded from analysis. Results: Twenty-three RCTs that met criteria were identified. The greatest number of RCTs involved risperidone, with six of seven placebo-controlled risperidone trials reporting statistically significant improvements on the primary outcome measure. Two aripiprazole RCTs and one olanzapine RCT reported statistically significant improvement in primary outcome measures. Haloperidol was superior to both clomipramine and placebo in a head-to-head crossover trial, while risperidone was superior to haloperidol for treatment of behavioural symptoms in a separate head-to-head trial. Clonidine, methylphenidate, valproate and levocarnitine monotherapy were superior to placebo in single RCTs, while adjunctive treatments cyproheptadine, pentoxifylline and topiramate were superior to placebo in small studies when given in combination with an antipsychotic. Adverse events from RCTs were summarized, including weight gain and metabolic effects, if available. Conclusion: The bulk of positive RCT evidence for the pharmacotherapy of irritability of autism pertains to FDA approved antipsychotics risperidone and aripiprazole. RCTs supporting efficacy of several alternative and adjunctive agents may afford additional treatment options when optimal antipsychotic doses fail to control symptoms or cause intolerable adverse effects. Behavioural therapy should be employed where possible either before, or in addition to pharmacotherapy.
机译：目的：回顾有关自闭症易怒性药物治疗的随机对照试验数据。方法：文献检索使用MEDLine搜索词：“自闭症”或“自闭症谱系障碍”，但有以下限制：随机对照试验（RCT），人体试验，英语。从参考信息中识别出其他文章。涉及营养补充剂，激素或未经加拿大卫生部或美国食品药品监督管理局（FDA）批准的药物的试验被排除在分析之外。结果：确定了二十三项符合标准的RCT。最多的随机对照试验涉及利培酮，七项安慰剂对照利培酮试验中有六项报告了主要结局指标的统计学显着改善。两项阿立哌唑随机对照试验和一种奥氮平随机对照试验报告了主要结局指标的统计学显着改善。在一项头对头交叉试验中，氟哌啶醇优于氯米帕明和安慰剂，而利培酮在一项单独的头对头试验中在行为症状治疗方面优于氟哌啶醇。在单项RCT中，可乐定，哌醋甲酯，丙戊酸丙戊酸盐和左卡尼汀单药治疗优于安慰剂，而在联合抗精神病药的小规模研究中，赛庚啶，己酮可可碱和托吡酯的辅助治疗优于安慰剂。总结了来自RCT的不良事件，包括体重增加和代谢作用（如果可用）。结论：自闭症易怒药物治疗的大量RCT阳性证据与FDA批准的抗精神病药利培酮和阿立哌唑有关。当最佳抗精神病药物剂量无法控制症状或引起无法忍受的不良反应时，支持多种替代药物和辅助剂疗效的RCT可能会提供其他治疗选择。在药物治疗之前或之外，应尽可能进行行为治疗。

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