Salazar de Pablo, GonzaloMoreno Ruiz, María del CarmenArango López, CelsoParellada Redondo, María José2026-01-212026-01-212023-02-01Salazar de Pablo, G., Pastor Jordá, C., Vaquerizo-Serrano, J., Moreno, C., Cabras, A., Arango, C., Hernández, P., Veenstra-VanderWeele, J., Simonoff, E., Fusar-Poli, P., Santosh, P., Cortese, S., & Parellada, M. (2023). Systematic Review and Meta-analysis: Efficacy of Pharmacological Interventions for Irritability and Emotional Dysregulation in Autism Spectrum Disorder and Predictors of Response. Journal of the American Academy of Child and Adolescent Psychiatry, 62(2), 151–168. https://doi.org/10.1016/j.jaac.2022.03.0330890-856710.1016/j.jaac.2022.03.033https://hdl.handle.net/20.500.14352/130735Objective: Emotional dysregulation and irritability are common in individuals with autism spectrum disorder (ASD). We conducted the first meta-analysis assessing the efficacy of a broad range of pharmacological interventions for emotional dysregulation and irritability in ASD and predictors of response. Method: Following a preregistered protocol (PROSPERO: CRD42021235779), we systematically searched multiple databases until January 1, 2021. We included placebo-controlled randomized controlled trials (RCTs) and evaluated the efficacy of pharmacological interventions and predictors of response for emotional dysregulation and irritability. We assessed heterogeneity using Q statistics and publication bias. We conducted subanalyses and meta-regressions to identify predictors of response. The primary effect size was the standardized mean difference. Quality of studies was assessed using the Cochrane Risk of Bias Tool (RoB2). Results: A total of 2,856 individuals with ASD in 45 studies were included, among which 26.7% of RCTs had a high risk of bias. Compared to placebo, antipsychotics (standardized mean difference = 1.028, 95% CI = 0.824-1.232) and medications used to treat attention-deficit/hyperactivity disorder (ADHD) (0.471, 0.061-0.881) were significantly better than placebo in improving emotional dysregulation and irritability, whereas evidence of efficacy was not found for other drug classes (p > .05). Within individual medications, evidence of efficacy was found for aripiprazole (1.179, 0.838-1.520) and risperidone (1.074, 0.818-1.331). Increased rates of comorbid epilepsy (β = -0.049, p = .026) were associated with a lower efficacy. Conclusion: Some pharmacological interventions (particularly risperidone and aripiprazole) have proved efficacy for short-term treatment of emotional dysregulation and irritability in ASD and should be considered within a multimodal treatment plan, taking into account also the tolerability profile and families' preferences.engAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/journal article1527-5418https://doi.org/10.1016/j.jaac.2022.03.03335470032https://linkinghub.elsevier.com/retrieve/pii/S0890-8567(22)00198-8https://pubmed.ncbi.nlm.nih.gov/35470032/open access616.89Autism Spectrum DisorderEmotional dysregulationIrritabilityPsiquiatría3211 Psiquiatría