Effectiveness and Tolerability of Switching to Aripiprazole From Risperidone in Subjects With Autism Spectrum Disorders

Ishitobi, Makoto; Kosaka, Hirotaka; Takahashi, Tetsuya; Yatuga, Chiho; Asano, Mizuki; Tanaka, Yuji; Ueno, Kanji; Okazaki, Ryoko; Omori, Masao; Hiratani, Michio; Tomoda, Akemi; Wada, Yuji

doi:10.1097/wnf.0b013e3182a31ec0

Cited by 24 publications

(7 citation statements)

References 30 publications

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“…The limited use of aripiprazole would be an indication of adherence to standard treatment guidelines in South Africa, which lists risperidone as the only drug for the management of irritability, aggression, or self-injurious behaviour in children diagnosed with ASD (18). The switch from risperidone to aripiprazole in this study is in line with an international prospective study which concluded that aripiprazole might be generally well tolerated and may constitute an alternative treatment for individuals with ASD who experience poor e cacy or tolerability issues with risperidone treatment (19).…”

Section: Discussionsupporting

confidence: 83%

An overview of pharmacotherapy in the management of children diagnosed with autism spectrum disorder at a public hospital in KwaZulu-Natal, South Africa

Maniram

Oosthuizen

Karrim

2022

Preprint

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Background The pharmacological management of Autism Spectrum Disorder (ASD) remains a challenge due to limited effective treatment options, the Food and Drug Administration's (FDA) approval of only two drugs, and the absence of drugs that can cure the core symptoms. In South Africa, little is known about the role of pharmacotherapy in the management of children diagnosed with ASD. This study presents an overview of prescribing patterns and provides insight into the current management practice for the core symptoms and comorbidities of ASD in children. Method A quantitative retrospective study was conducted at a public hospital in Kwa-Zulu Natal, South Africa by reviewing patient files of children diagnosed with ASD and meeting the inclusion criteria for the study. A descriptive analysis of data was done to identify treatment trends and patient therapeutic outcomes. Results A total of 181 children met the inclusion criteria of the study. Risperidone was the most frequently prescribed drug (88%) for the management of comorbidities and/or core symptoms of ASD. Attention deficit hyperactivity disorder (54%), irritability or aggression (25%), and sleep dysregulation (22%) were frequent ASD comorbidities that warranted pharmacotherapy. Drugs prescribed to manage ASD comorbidities included methylphenidate, melatonin, sodium valproate, risperidone, oxybutynin, carbamazepine, and others. Except for risperidone, there were no additional drugs that targeted the core symptoms of ASD. Non-pharmacological therapies were often used collaboratively with medication to manage ASD symptoms. The use of psychotropic drug combinations was influenced by the age and gender of a child. In 41% of patients, there were improvements in their symptoms (comorbidities and/or core symptoms) which indicated a positive response to the treatment plan. Conclusion Drugs played a prominent role in managing the comorbidities of ASD, however, pharmaco-therapeutic options for the management of ASD core symptoms are limited. As the availability and use of additional effective drugs (including vitamin, mineral, and dietary supplements) for the management of ASD increases, improved therapeutic outcomes for children with ASD in South Africa could be achievable.

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Section: Discussionsupporting

confidence: 83%

An overview of pharmacotherapy in the management of children diagnosed with autism spectrum disorder at a public hospital in KwaZulu-Natal, South Africa

Maniram

Oosthuizen

Karrim

2022

Preprint

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“…A recent large-scale systematic meta-review showed that both treatments presented an increased risk for weight gain in children and adolescents ( Solmi et al, 2020 ). In this regard, there has been an increase in evidence comparing the effects of these 2 antipsychotics on these populations in recent years ( Ishitobi et al, 2013 ; Wink et al, 2014 ; Nicol et al, 2018 ; Schoemakers et al, 2019 ; Cicala et al, 2020 ). Head-to-head comparison studies between aripiprazole and risperidone in these populations showed similar results on weight gain and lipid/glycemic parameters, in both the short term (6–12 weeks) ( Ishitobi et al, 2013 ; Nicol et al, 2018 ) and long-term (1 year) ( Wink et al, 2014 ; Schoemakers et al, 2019 ; Cicala et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Aripiprazole and Risperidone Present Comparable Long-Term Metabolic Profiles: Data From a Pragmatic Randomized Controlled Trial in Drug-Naïve First-Episode Psychosis

Vázquez-Bourgon

Foz

Gómez-Revuelta

et al. 2022

International Journal of Neuropsychopharmacology

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Objective Aripiprazole and risperidone are two of the most used second-generation antipsychotics (SGAs) worldwide. Previous evidence shows a similar effect of these SGAs on weight and metabolic changes at short-term. However, a longer period of time is necessary for a better assessment of their metabolic profile. We aimed to compare the long-term (1-year) metabolic profile of these two antipsychotics on a sample of drug-naïve first episode-psychosis (FEP) patients. Methods One hundred and eighty-eight drug-naïve patients, suffering from a first episode of non-affective psychosis (FEP), were randomly assigned to treatment either with aripiprazole or risperidone. Weight and glycemic/lipid parameters were recorded at baseline and after 1-year follow-up. Results We observed significant weight increments in both groups (9.2 kg for aripiprazole and 10.5 kgs for risperidone) after 1 year of treatment. Despite of this, we found no significant differences in weight or body mass index (BMI) changes between treatment groups (p>0.05). Similarly, both treatment groups presented similar metabolic clinical impact with a comparable increase in the proportion of subjects meeting criteria for metabolic disorders such as obesity or hypercholesterolemia, but not for metabolic syndrome (Δ9.2% vs Δ4.3%) or hypertriglyceridemia (Δ21.9% vs Δ8.0%) where aripiprazole showed worse outcomes than risperidone. Conclusion The study shows that aripiprazole and risperidone share a similar long-term metabolic profile. After 1-year of antipsychotic treatment, drug-naïve FEP patients in both treatment groups presented a significant rise in weight and metabolic changes leading to a greater prevalence of metabolic disorders.

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“…13 The atypical antipsychotics risperidone and aripiprazole have been reported to be efficacious in treating aggression, selfinjurious behavior, and severe tantrums in children and adolescents. 14,15 Both medications are FDA (Food and Drug Administration) approved in children and adolescents between 6 and 17 years old. Although second-generation or atypical antipsychotic drugs were developed to reduce the frequency of extrapyramidal syndrome, 16 there is still a frequent risk of adverse effects in children and adolescents taking risperidone or aripiprazole.…”

Section: Introductionmentioning

confidence: 99%

Behavioral Mechanisms That Depend on Dopamine and Serotonin in Caenorhabditis elegans Interact With the Antipsychotics Risperidone and Aripiprazole

et al. 2018

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The neurotransmitters dopamine and serotonin participate in specific behavioral neuromuscular mechanisms in the nematode Caenorhabditis elegans. Dopamine is involved in the gentle touch response and serotonin in the pharyngeal pumping rate. In its genome, the worm presents genes encoding dopamine and serotonin receptors orthologous to those of human genes. Risperidone and aripiprazole are a class of drugs known as atypical antipsychotics commonly used to treat schizophrenia, bipolar disorder, and irritability associated with autism. Risperidone is an antagonist of the dopamine D2 and serotonin 5-HT2A receptors. Aripiprazole functions as a partial agonist of the dopamine D2 receptor and as a partial agonist and antagonist of 5-HT1A and 5-HT2A serotonin receptors, respectively. Our results show that risperidone and aripiprazole alter the touch response and pharyngeal pumping in wild-type worm animals. Furthermore, in the presence of the drugs, both behaviors change to varying degrees in dopamine (dop-1, dop-2, and dop-3), serotonin (ser-1), and tyramine (ser-2) receptor-deficient mutants. This variation in response reveals specific targets for these antipsychotics in the nematode. Interestingly, their effect on behavior persisted to some extent in successive generations, indicating that they might induce epigenetic changes throughout development. Sodium butyrate, a histone deacetylase inhibitor, eliminated the consecutive generation effect of both drugs. In addition, these transgenerational effects were also abolished after the dauer stage. These observations suggest that risperidone and aripiprazole, in addition to interacting with specific receptors impairing the function of the nervous system of the nematode, may lead to the deposition of long-lasting epigenetic marks.

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Effectiveness and Tolerability of Switching to Aripiprazole From Risperidone in Subjects With Autism Spectrum Disorders

Cited by 24 publications

References 30 publications

An overview of pharmacotherapy in the management of children diagnosed with autism spectrum disorder at a public hospital in KwaZulu-Natal, South Africa

An overview of pharmacotherapy in the management of children diagnosed with autism spectrum disorder at a public hospital in KwaZulu-Natal, South Africa

Aripiprazole and Risperidone Present Comparable Long-Term Metabolic Profiles: Data From a Pragmatic Randomized Controlled Trial in Drug-Naïve First-Episode Psychosis

Behavioral Mechanisms That Depend on Dopamine and Serotonin in Caenorhabditis elegans Interact With the Antipsychotics Risperidone and Aripiprazole

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