The pediatric psychopharmacology of autism spectrum disorder: A systematic review - Part II: The future

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#humans #autism-spectrum-disorder #child #psychopharmacology #randomized-controlled-trials-as-topic

The pediatric psychopharmacology of autism spectrum disorder: A systematic review - Part II: The future

Persico et al., 2025 | Prog Neuropsychopharmacol Biol Psychiatry | Systematic Review

Citation

Persico Antonio M, Asta Lisa, ... Vitiello Benedetto. The pediatric psychopharmacology of autism spectrum disorder: A systematic review - Part II: The future. Prog Neuropsychopharmacol Biol Psychiatry. 2025-Jan-10;136:111176. doi:10.1016/j.pnpbp.2024.111176

Abstract

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.

Key Findings

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.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 57
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Autism Spectrum Disorder
  • Child
  • Psychopharmacology
  • Randomized Controlled Trials as Topic
  • Psychotropic Drugs
  • Adolescent
  • Dietary Supplements

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Systematic Review, Journal Article
  • Vertical: coq10

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09