Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
• Introduction
  • Background
  • Objectives
  • Scope of Review and Key Questions
  • Analytic Framework
  • Organization of This Report
• Methods
  • Topic Refinement and Review Protocol
  • Inclusion/Exclusion Criteria
  • Literature Search Strategy
  • Study Selection
  • Data Abstraction and Data Management
  • Assessment of Methodological Quality of Individual Studies
  • Data Synthesis
  • Grading the Strength of the Body of Evidence
  • Interpretations Throughout Report
  • Applicability
  • Peer Review and Public Commentary
• Results
  • Literature Search and Screening
  • Description of Included Studies
  • Methodological Quality of Included Studies
  • Key Question 1. Intermediate and Effectiveness Outcomes
  • Key Question 2. Harms
• Discussion
  • Key Findings for Intermediate and Effectiveness Outcomes Within Each Condition (Key Question 1)
  • Key Findings for Harms Across All Conditions (Key Question 2)
  • Applicability of Findings
  • Findings in Relation to What Is Known
  • Implications for Clinical and Policy Decisionmakers
  • Limitations of This CER
  • Limitations of the Evidence Base
  • Research Gaps
  • Conclusions
• References
• Abbreviations and Acronyms
• Appendix A. Changes From Original Review
• Appendix B. Literature Search Strategies
• Appendix C. Quality Assessment Ratings
• Appendix D. Study Characteristics
• Appendix E. Associated Publications
• Appendix F. Excluded Studies
• Appendix G. Analytical Models and Code, and Additional Results for Key Question 2 From Network Meta-Analysis and for General Adverse Effects

Errata

In the original version of this report there was an error with respect to review findings for gains in weight and body mass index (BMI) from the trial on lurasidone for the treatment of irritability associated with autistic disorder (Loebel et al. J Autism Dev Disord 2016;46:1153-63). We thank Sunovion Pharmaceuticals for bringing this to our attention. Our original report used data for the mean change in percentile instead of the mean change in raw measure of kilograms (kg) and kg·m^-2, which led to higher values used for between-group differences in weight and BMI: mean weight change for lurasidone (doses pooled) versus placebo was 0.45 kg not 2.67 kg, and mean change in BMI was 0.15 kg·m^-2 rather than 2.92 kg·m^-2.

We updated the following analyses for Key Question 2 about the effect of olanzapine compared with lurasidone on weight gain and BMI: network meta-analysis for body composition outcomes across all conditions; analysis for SGA vs. placebo; and analysis for between- and within study subgroup effects. Based on the updated data this changed our original conclusion that olanzapine did not appear to cause greater weight gain or higher BMI than lurasidone. We now find that olanzapine appears to cause greater weight gain or higher BMI than other SGAs, including lurasidone. Our main conclusion that the most robust findings were of olanzapine being worse for weight gain and BMI than risperidone, ziprasidone, and aripiprazole (because of precision in findings for these drugs) remains the same.

We have revised the relevant parts of this report with the updated data.

Suggested citation:

Pillay J, Boylan K, Carrey N, Newton A, Vandermeer B, Nuspl M, MacGregor T, Ahmed Jafri SH, Featherstone R, Hartling L. First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update. Comparative Effectiveness Review No. 184. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-2015-00001-I.) AHRQ Publication No. 17-EHC001-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2017. Errata January 2018. www.effectivehealthcare.ahrq.gov/reports/final/cfm. doi: https://doi.org/10.23970/AHRQEPCCER184.

This report is based on research conducted by the University of Alberta Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00001-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

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