Aripiprazole for treating irritability associated with autism spectrum disorders

ABSTRACT

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a reported prevalence of 1 in 59 people. Its core features are persistent deficits in social communication and restricted, repetitive patterns of behavior or interests. Individuals with ASD have a high incidence of secondary problems with mood lability, tantrums, self-injurious behavior and aggressiveness toward others. Collectively, these behaviors are often referred to as irritability. Many medications have been used to treat irritability in autism, with aripiprazole one of only two medications approved in the USA for this purpose.

Areas covered: Herein, the authors review the evidence supporting the use of aripiprazole for treating irritability in autism, including the pivotal trials leading to regulatory approval and long-term studies conducted post-approval. They utilized PubMed, searching all English language publications since 2000, using the terms aripiprazole, autism, autism spectrum disorder, pervasive developmental disorder, Asperger’s disorder, and irritability, and focused on clinical trials and review articles.

Expert opinion: Multiple studies have shown the clear benefit of aripiprazole in the treatment of irritability in autism disorders compared to placebo. Often underemphasized are the metabolic effects, the proper monitoring for these effects, and the need for periodic reassessment to determine if ongoing treatment is needed.

KEYWORDS:

• Aggression
• antipsychotic medication
• aripiprazole
• autism spectrum disorders
• dopamine agonists
• dyskinesia
• extrapyramidal symptoms
• irritability
• self-injurious behavior
• weight gain

Article highlights

• Autism spectrum disorder is a neurobehavioral disorder manifested by problems with social communication, and with restricted interests and/or repetitive behaviors.

• At this time there are no medical treatments for the core symptoms of autism. As a result, pharmacotherapy is directed toward secondary symptoms or conditions such as anxiety, hyperactivity and irritability.

• Irritability, comprised of severe tantrums, mood swings and aggressive behavior, is identified by family members as the most problematic behavior in people with autism.

• Evidence exists supporting effectiveness of two atypical antipsychotic medications in the treatment of irritability in autism.

• Aripiprazole can be a useful treatment for irritability in autism, but careful monitoring for neurologic and metabolic side effects must be conducted.

Declaration of interest

DL Coury has served on advisory boards for Cognoa, BioROSA and Quadrant Biosciences. He has also received grant support from Stemina Biosciences, Neurim, and Stalicla. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This manuscript has not been funded.