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.