Wide Variability in Drugs Used to Manage Conditions Associated With Autism

NEW YORK (Reuters Health) – There is wide variability in medications prescribed in the United States to manage symptoms and comorbidities associated with autism-spectrum disorder (ASD), a large study has found.

Although there is no medical treatment for the core deficits of social communication and repetitive behavioral patterns in ASD, guidance from the American Academy of Pediatrics suggests clinicians consider medications in the management of common related conditions, including seizures, attention-deficit/hyperactivity disorder (ADHD), anxiety and mood disorders, and disruptive behavior disorders.

“A better understanding of the medications used to manage comorbid conditions in this growing population is critical; however, most previous efforts have been limited in size, duration, and lack of broad representation,” researchers explain in JAMA Pediatrics.

Dr. Paul Avillach of Harvard Medical School, in Boston, and colleagues assessed trends in medication use in the management of comorbidities among more than 26,000 individuals with ASD (78% male; mean age, 14 years) using a database of national managed-care-plan claims.

They found that polypharmacy (three or more medication at once) was common, ranging from 28.6% to 31.5%, from 2014 to 2019.

This estimate is higher than in other studies, which have found psychotropic-polypharmacy rates ranging from 6.7% to 22%. Dr. Avillach and colleagues say the higher rate in their study may stem from the broader slate of common medications they included (24 in total) compared with prior studies that looked at fewer medications.

Their study also showed that individuals’ prescription regimens changed frequently within medication classes, rather than between classes.

It appears that many young people with ASD undergo treatment with a wide variety of medications on a trial basis, resulting in frequent changes in drug regimens over time as clinicians attempt to manage associated symptoms and comorbidities, Dr. Avillach and colleagues report.

The “high rates of polypharmacy and medication transiency raise concerns about the efficacy of current medications in managing comorbidities as they occur in the context of ASD,” they write.

A notable finding, the team adds, is that medication prescriptions did not appear to be completely explained by associated comorbid conditions.

“For example, 15% or more of individuals in 15 of 24 medication groups had a mood disorder, which is not the primary indication for several of these medications, including aripiprazole, atomoxetine, and quetiapine. Similarly, some medications (eg, diazepam, dextroamphetamine, and lamotrigine) appear to be weakly associated with many different comorbidities,” they point out.

“These trends suggest that clinicians may be using these medications to treat ASD symptoms, even without diagnoses of comorbidities, or that pharmacologically treating these complex conditions is challenging and requires trials of several medications to achieve relief,” they suggest.

“Future research and policy efforts are critical to assess the extent to which pharmacological management of comorbidities affects quality of life and functioning in patients with ASD, while continuing to optimize clinical guidelines, to ensure effective care for this growing population,” Dr. Avillach and colleagues conclude.

The study had no specific funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/3fWHJSy JAMA Pediatrics, online June 7, 2021.

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