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Antipsychotics for children and young adults: a comparative effectiveness review.
Pediatrics. 2012 Mar; 129(3):e771-84.Ped

Abstract

BACKGROUND AND OBJECTIVE

Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions.

METHODS

We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate.

RESULTS

Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome).

CONCLUSIONS

This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed.

Authors+Show Affiliations

Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. jennifer.seida@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.
Review

Language

eng

PubMed ID

22351885

Citation

Seida, Jennifer C., et al. "Antipsychotics for Children and Young Adults: a Comparative Effectiveness Review." Pediatrics, vol. 129, no. 3, 2012, pp. e771-84.
Seida JC, Schouten JR, Boylan K, et al. Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics. 2012;129(3):e771-84.
Seida, J. C., Schouten, J. R., Boylan, K., Newton, A. S., Mousavi, S. S., Beaith, A., Vandermeer, B., Dryden, D. M., & Carrey, N. (2012). Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics, 129(3), e771-84. https://doi.org/10.1542/peds.2011-2158
Seida JC, et al. Antipsychotics for Children and Young Adults: a Comparative Effectiveness Review. Pediatrics. 2012;129(3):e771-84. PubMed PMID: 22351885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antipsychotics for children and young adults: a comparative effectiveness review. AU - Seida,Jennifer C, AU - Schouten,Janine R, AU - Boylan,Khrista, AU - Newton,Amanda S, AU - Mousavi,Shima S, AU - Beaith,Amy, AU - Vandermeer,Ben, AU - Dryden,Donna M, AU - Carrey,Normand, Y1 - 2012/02/20/ PY - 2012/2/22/entrez PY - 2012/2/22/pubmed PY - 2012/4/26/medline SP - e771 EP - 84 JF - Pediatrics JO - Pediatrics VL - 129 IS - 3 N2 - BACKGROUND AND OBJECTIVE: Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions. METHODS: We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate. RESULTS: Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome). CONCLUSIONS: This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/22351885/Antipsychotics_for_children_and_young_adults:_a_comparative_effectiveness_review_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=22351885 DB - PRIME DP - Unbound Medicine ER -