Pharmacologic Treatment of Repetitive Behaviors in Autism Spectrum Disorders: Evidence of Publication Bias

Pediatrics, 05/14/2012

Carrasco M et al. – Meta–analysis of the published literature suggests a small but significant effect of serotonin receptor inhibitors (SRIs) in the treatment of repetitive behaviors in autism spectrum disorders (ASD). This effect may be attributable to selective publication of trial results. Without timely, transparent, and complete disclosure of trial results, it remains difficult to determine the efficacy of available medications.

Methods

  • Two reviewers searched PubMed and Clinicaltrials.gov for randomized, double-blind, placebo-controlled trials evaluating the efficacy of SRIs for repetitive behaviors in ASD.
  • Publication bias was assessed by using a funnel plot, the Egger’s test, and a meta-regression of sample size and effect size.

Results

  • Meta-analysis of 5 published and 1 unpublished trial (which provided data) demonstrated a small but significant effect of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.22 [95% confidence interval: 0.07–0.37], z score = 2.87, P < .005).
  • There was significant evidence of publication bias in all analyses.
  • When Duval and Tweedie's trim and fill method was used to adjust for the effect of publication bias, there was no longer a significant benefit of SRI for the treatment of repetitive behaviors in ASD (standardized mean difference: 0.12 [95% confidence interval: –0.02 to 0.27]).
  • Secondary analyses demonstrated no significant effect of type of medication, patient age, method of analysis, trial design, or trial duration on reported SRI efficacy.

Print Article Summary Cat 2 CME Report