Pharmacological treatments use among children, adolescents and young adults with autism spectrum disorder in France: An overview based on parental experience. Traitements médicamenteux reçus par les enfants, adolescents et jeunes adultes avec trouble du spectre autistique en France : un état des lieux basé sur l’expérience parentale

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Cravero, C | Guinchat, V | Claret-Tournier, A | Sahnoun, C | Bonniau, Béatrice | Bodeau, N | Danion-Grilliat, A | Cohen, D | Chamak, Brigitte

Edité par CCSD ; Elsevier Masson -

International audience. BackgroundMedications are widely used among people with autism spectrum disorder (ASD). Few publications, however, document pharmacological prescriptions in autism in France. Our study provides an overview of the use of pharmacological treatments based on parental reports, and assesses the factors that influence their prescription.Patients and methodsWe conducted a retrospective cohort study in France from 2005 to 2007. The parents of 393 children, adolescents and adults with ASD (mean age 12.0 years (SD = 8.6), range: 1–45) filled a questionnaire on their child's treatment prescription, including among others the name of the drug, the age of onset and treatment duration, and observed efficacy and side effects.ResultsOverall, 52% (n = 203) of individuals have taken medication and 35% (n = 139) retained the treatment, with at least two psychotropic medications in 10.5% of cases (n = 40). The mean age of the first prescription was 9.4 years (SD = 6.4). The mean duration of prescription was 5.0 years (SD = 6.7). Atypical antipsychotics (APA) (23%, n = 88) and conventional (13%, n = 49) were the most commonly prescribed, followed by anticonvulsants (9%, n = 36). The number of treatments received was associated with age (U = 8908.5, P < 0.001), severity of autism (rho = 0.29; bootstrap [95% CI: 0.18–0.38]), delay in diagnosis (rho = 0.13 [95% CI: 0.22–0.26]), institutionalization (U = 7803.5, P < 0.01) and treatment duration (rho = 0.34 [95% CI: 0.21–0.52]), and was not associated with gender or socioeconomic status. A third of parents (32%, n = 127) noted a global efficacy of treatment. Eleven percent (n = 45) reported side effects, including sedation (6%, n = 24) and weight gain (4%, n = 15). The risk of adverse effects increased in case of APA (OR = 56.1 [95% CI: 12.4–521.4], P < 0.01), polypharmacy (U = 2732.5, P < 0.01) and off-label prescription (OR = 2.4 [95% CI: 1.1–5.1], P = 0.031). Each additional prescription increases by 2.4 times the risk of developing side effects.ConclusionThe high prevalence of people with autism who received or pursuing pharmacological treatment questions, given the poor evidence of their effectiveness and their significant side effects. . Objectifs Les personnes atteintes de troubles du spectre autistique (TSA) reçoivent régulièrement un traitement. Pourtant, peu de publications documentent les prescriptions médicamenteuses dans l’autisme en France. Notre étude offre un état des lieux de l’usage des traitements pharmacologiques d’après constat parental, et évalue les facteurs susceptibles d’influencer leur prescription. Patients et méthodes Nous avons réalisé une étude rétrospective de cohorte en France entre 2005 à 2007. Les parents de 393 enfants, adolescents et adultes avec TSA (âge moyen : 12,0 ans [±8,6], rang : 1–45) ont renseigné un questionnaire sur les traitements reçus par leur enfant, comprenant entre autres le nom de la molécule, l’âge de début et la durée du traitement, et les effets observés. Résultats Dans l’ensemble, 52 % (n=203) des individus ont pris un traitement médicamenteux et 35 % (n=139) l’ont conservé, avec au moins deux psychotropes dans 10,5 % des cas (n=40). Les antipsychotiques atypiques (APA) (23 %, n=88) et classiques (13 %, n=49) étaient les plus prescrits, suivis des antiépileptiques (9 %, n=36). Le risque d’effets indésirables augmentait en cas d’APA (OR=56,1 [12,4–521,4], p<0,01), de poly-prescription (U=2732,5, p<0,01) et de prescription hors autorisation de mise sur le marché (OR=2,4 [1,1,–5,1], p=0,031). Le nombre de traitements reçus était corrélé à un âge élevé (U=8908,5, p<0,001), à la sévérité de l’autisme (rho=0,29 ; IC bootstrap [0,18–0,38]), à un diagnostic tardif (rho=0,13 [0,22–0,26]), à l’institutionnalisation (U=7803,5, p<0,01) et à la durée de prescription (rho=0,34 [0,21–0,52]). Conclusion La prévalence des personnes avec autisme ayant reçu ou poursuivant un traitement pharmacologique interroge, étant donné les faibles preuves de leur efficacité et leurs effets indésirables notables. Background : Medications are widely used among people with autism spectrum disorder (ASD). Few publications, however, document pharmacological prescriptions in autism in France. Our study provides an overview of the use of pharmacological treatments based on parental reports, and assesses the factors that influence their prescription. Patients and methods We conducted a retrospective cohort study in France from 2005 to 2007. The parents of 393 children, adolescents and adults with ASD (mean age 12.0 years (SD=8.6), range: 1–45) filled a questionnaire on their child's treatment prescription, including among others the name of the drug, the age of onset and treatment duration, and observed efficacy and side effects. Results Overall, 52% (n=203) of individuals have taken medication and 35% (n=139) retained the treatment, with at least two psychotropic medications in 10.5% of cases (n=40). The mean age of the first prescription was 9.4 years (SD=6.4). The mean duration of prescription was 5.0 years (SD=6.7). Atypical antipsychotics (APA) (23%, n=88) and conventional (13%, n=49) were the most commonly prescribed, followed by anticonvulsants (9%, n=36). The number of treatments received was associated with age (U=8908.5, P<0.001), severity of autism (rho=0.29; bootstrap [95% CI: 0.18–0.38]), delay in diagnosis (rho=0.13 [95% CI: 0.22–0.26]), institutionalization (U=7803.5, P<0.01) and treatment duration (rho=0.34 [95% CI: 0.21–0.52]), and was not associated with gender or socioeconomic status. A third of parents (32%, n=127) noted a global efficacy of treatment. Eleven percent (n=45) reported side effects, including sedation (6%, n=24) and weight gain (4%, n=15). The risk of adverse effects increased in case of APA (OR=56.1 [95% CI: 12.4–521.4], P<0.01), polypharmacy (U=2732.5, P<0.01) and off-label prescription (OR=2.4 [95% CI: 1.1–5.1], P=0.031). Each additional prescription increases by 2.4 times the risk of developing side effects. Conclusion The high prevalence of people with autism who received or pursuing pharmacological treatment questions, given the poor evidence of their effectiveness and their significant side effects.

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