自闭症谱系障碍的儿科精神药理学:系统综述第二部分:未来。

IF 5.3 2区 医学 Q1 CLINICAL NEUROLOGY Progress in Neuro-Psychopharmacology & Biological Psychiatry Pub Date : 2024-10-28 DOI:10.1016/j.pnpbp.2024.111176
Antonio M. Persico , Lisa Asta , Fethia Chehbani , Silvestro Mirabelli , Valeria Parlatini , Samuele Cortese , Celso Arango , Benedetto Vitiello
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引用次数: 0

摘要

自闭症谱系障碍(ASD)是一种严重的终身性神经发育障碍,本系统综述的第一部分总结了自闭症谱系障碍儿科精神药理学的最新进展。本文第二部分的目的是系统地概述 ASD 的实验精神药理学。为此,我们首先在 Clinicaltrials.gov 网站上确定了所有 157 种药物和营养保健品,这些药物和保健品采用随机安慰剂对照试验 (RCT) 设计,在患有 ASD 的儿童和青少年身上进行了实验测试。在剔除第一部分已介绍的 24 种药物后,我们在 Prospero(ID:CRD42023476555)上对剩余的 133 种化合物逐一进行了系统综述(ID:CRD42023476555),在 PubMed(2024 年 8 月 8 日)上进行了综述,并在 EBSCO、PsycINFO(心理学和精神病学文献)和 Cochrane 系统综述数据库中完成了综述,共获得 115 项已发表的 RCT,其中包括 23 种药理化合物的 57 项试验和 17 种营养品/补充剂的 48 项试验。褪黑素和催产素未包括在内,因为这两种化合物最近都已发表了系统综述。阿巴洛芬、巴洛伐坦和布美他尼等临床前研究基础最为雄厚的药物的临床试验均未能达到主要终点,但针对特定患者亚群的研究确实值得进一步研究。包括大麻二酚、血管加压素和益生菌在内的绝大多数化合物的疗效和安全性证据不足。然而,一小部分化合物,包括 N-乙酰半胱氨酸、亚叶酸、左旋肉碱、辅酶 Q10、舒乐安定和二甲双胍,已经可以在谨慎的情况下考虑用于临床,因为已经有了很好的疗效证据和较高的安全性。至于其他几种化合物,如胰泌素,其疗效可以肯定地排除,并且/或者数据不鼓励进行新的 RCT 研究。第一部分和第二部分总结了 "以药物为基础 "的信息,这些信息最终将合并到第三部分,为临床医生提供一份 "以症状为基础 "的共识声明,其总体目标是促进循证临床实践,并为未来的临床试验制定新的策略。
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The pediatric psychopharmacology of autism spectrum disorder: A systematic review - Part II: The future
Part I of this systematic review summarized the state-of-the-art of pediatric psychopharmacology for Autism Spectrum Disorder (ASD), a severe and lifelong neurodevelopmental disorder. The purpose of this Part II follow-up article is to provide a systematic overview of the experimental psychopharmacology of ASD. To this aim, we have first identified in the Clinicaltrials.gov website all the 157 pharmacological and nutraceutical compounds which have been experimentally tested in children and adolescents with ASD using the randomized placebo-controlled trial (RCT) design. After excluding 24 drugs already presented in Part I, a systematic review spanning each of the remaining 133 compounds was registered on Prospero (ID: CRD42023476555), performed on PubMed (August 8, 2024), and completed with EBSCO, PsycINFO (psychology and psychiatry literature) and the Cochrane Database of Systematic reviews, yielding a total of 115 published RCTs, including 57 trials for 23 pharmacological compounds and 48 trials for 17 nutraceuticals/supplements. Melatonin and oxytocin were not included, because recent systematic reviews have been already published for both these compounds. RCTs of drugs with the strongest foundation in preclinical research, namely arbaclofen, balovaptan and bumetanide have all failed to reach their primary end-points, although efforts to target specific patient subgroups do warrant further investigation. For the vast majority of compounds, including cannabidiol, vasopressin, and probiotics, insufficient evidence of efficacy and safety is available. However, a small subset of compounds, including N-acetylcysteine, folinic acid, l-carnitine, coenzyme Q10, sulforaphane, and metformin may already be considered, with due caution, for clinical use, because there is promising evidence of efficacy and a high safety profile. For several other compounds, such as secretin, efficacy can be confidently excluded, and/or the data discourage undertaking new RCTs. Part I and Part II summarize “drug-based” information, which will be ultimately merged to provide clinicians with a “symptom-based” consensus statement in a conclusive Part III, with the overarching aim to foster evidence-based clinical practices and to organize new strategies for future clinical trials.
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来源期刊
CiteScore
12.00
自引率
1.80%
发文量
153
审稿时长
56 days
期刊介绍: Progress in Neuro-Psychopharmacology & Biological Psychiatry is an international and multidisciplinary journal which aims to ensure the rapid publication of authoritative reviews and research papers dealing with experimental and clinical aspects of neuro-psychopharmacology and biological psychiatry. Issues of the journal are regularly devoted wholly in or in part to a topical subject. Progress in Neuro-Psychopharmacology & Biological Psychiatry does not publish work on the actions of biological extracts unless the pharmacological active molecular substrate and/or specific receptor binding properties of the extract compounds are elucidated.
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