Analysis Of The Efficacy And Safety Of Pharmacological And Dietary Interventions In Autism Spectrum Disorder

BackgroundAutism spectrum disorder(ASD)is a type of neurodevelopmental disorders that starts in early childhood,with characteristic symptoms of social interaction and communication disorder,language delay and repetitive patterns of behavior.At present,there are many treatments for ASD,but the efficacy and safety of these methods are still controversial..This network meta-analysis was designed to investigate the efficacy and safety of pharmacological and dietary interventions for ASD.MethodsClinicaltrials.gov,PubMed,EMbase,The Cochrane Library,CNKI and WanFang Data databases were electronically searched to collect randomized controlled trial(RCT)of aripiprazole,atomoxetine,bumetanide,oxytocin,fluoxetine,risperidone,sulforaphane,memantine,ketogenic diet,vitamin D,Gluten-Free and Casein-Free diet,probiotics,omega-3 fatty acids in the treatment of autism spectrum disorder(up to May 4,2022).Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies;then,network meta-analysis was performed by using Stata 16.0 software.This research protocol has been registered with PROSPERO(ID:CRD42022380113).ResultsA total of 42 RCTs involving 3076 patients were included.The following medications could improve at least one symptom in comparison with placebo:risperidone:social impairment[SMD=-11.40,95%CI(-14.67,-8.14)],stereotyped behavior[SMD=-2.25,95%CI(-4.33,-0.17)],irritability[SMD=-8.08,95%CI(-11.35,-4.81)],hyperactivity[SMD=-11.40,95%CI(-14.67,-8.14)],inappropriate speech[SMD=-2.14,95%CI(-3.28,-1.00)];aripiprazole:social impairment[SMD=-4.67,95%CI(-5.26,-4.08)],hyperactivity[SMD=4.67,95%CI(-5.26,-4.08];atomoxetine:social impairment[SMD=-4.37,95%CI(-5.75,-2.99)],hyperactivity[SMD=-4.37,95%CI(-5.75,-2.99)],inappropriate speech[SMD=-0.77,95%CI(-1.51,-0.03)];oxytocin:inappropriate speech[SMD=-2.20,95%CI(-4.09,-0.31)];memantine:stereotyped behavior[SMD=-8.47,95%CI(-12.78,-4.16)].The following dietary intervention could improve at least one symptom in comparison with placebo:sulforaphane:social impairment[SMD=-1.66,95%CI(-2.41,-0.91)],hyperactivity[k=1,n=30,SMD=-1.66,95%CI(-2.41,-0.91)].There was no significant difference in the incidence of serious adverse events and the withdrawal rate due to adverse reactions between the two groups.ConclusionCurrent evidence shows that risperidone,aripiprazole,atomoxetine,memantine,oxytocin,and sulforaphane can improve symptoms in patients with autism spectrum disorders,and their safety is satisfactory.Due to limited quality and quantity of the included studies,more high-quality studies are needed to verify above conclusion.