Intravenous secretin for autism spectrum disorders (ASD).
TL;DR: There is no evidence that single or multiple dose intravenous secretin is effective and as such currently it should not be recommended or administered as a treatment for ASD.
Abstract: BACKGROUND: In 1998 secretin, a gastrointestinal hormone, was suggested as an effective treatment for autism spectrum disorders (ASD) based on anecdotal evidence. OBJECTIVES: To assess whether intravenous secretin improves the core features of ASD, other aspects of behaviour or function such as self-injurious behaviour, and the quality of life of affected individuals and their carers. We also assessed whether secretin causes harm. This is an updated version of our review of this topic originally published in 2005. SEARCH METHODS: We searched CENTRAL (2010 Issue 1), MEDLINE (1950 to January 2010) , EMBASE (1980 to 2010 Week 2), PsycINFO (1806 to 2010 Week 2), CINAHL (1938 to January 2010), ERIC (1966 to January 2010), Sociological Abstracts (1952 to January 2010). Sociofile and HealthStar were searched in March 2005 when this review was first published, but were not available for this update. Records were limited to studies published since 1998 as this is when secretin was first proposed as a possible treatment for ASD. We searched reference lists of trials and reviews; we also contacted experts and trialists to find unpublished studies. SELECTION CRITERIA: Randomised controlled trials of intravenous secretin compared to a placebo treatment in children or adults diagnosed with ASD, where at least one standardised outcome measure was reported. DATA COLLECTION AND ANALYSIS: Sixteen studies met the inclusion criteria but for two of these, conducted by Repligen, the only available multisite data were reported in press releases. All outcome data from the other 14 trials were continuous. Where trials used cross-over designs, we conducted analysis on results from the first treatment phase. Where mean change from baseline was reported, we used this in preference to post-treatment scores for meta-analyses or forest plots. Meta-analysis was able to be attempted for only one outcome (Childhood Autism Rating Scale). Insufficient data were available to conduct sensitivity or subgroup analyses to assess the impact of study quality, clinical differences in the intervention or clinically relevant differences between groups, such as age or presence of gastrointestinal symptoms. MAIN RESULTS: Over 900 children were recruited for the secretin trials. Twenty-five established standardised outcome measures were reported to assess core features of ASD, communication, behaviour, visuospatial skills, affect and adverse events. One standardised measure of global impression was also used. No more than four studies used any one outcome measure similarly. When duration from the start of the intervention to outcome assessment was known, outcomes were reported at between three and six weeks. Meta-analysis of data was not possible but there is now consistency of findings, with RCTs of the efficacy of secretin in autism not showing improvements for core features of ASD. AUTHORS' CONCLUSIONS: There is no evidence that single or multiple dose intravenous secretin is effective and as such currently it should not be recommended or administered as a treatment for ASD. Further experimental assessment of secretin's effectiveness for ASD can only be justified if there is new high-quality and replicated scientific evidence that either finds that secretin has a role in neurotransmission in a way that could benefit all children with ASD or identifies important subgroups of children with ASD who could benefit from secretin because of a proven link between the action of secretin and the known cause of their ASD, or the type of problems they are experiencing.
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01 Jan 2012
TL;DR: Intensive research over the last years has led to a better understanding of, and improved therapeutic options for, autism spectrum disorders.
Abstract: Autistic disorders - the state of the art and recent findings: epidemiology, aetiology, diagnostic criteria, and therapeutic interventions This review article is based on a state-of-the-art lecture given at the 32nd meeting of the German Child Psychiatry Association in March 2011. It summarizes recent findings from epidemiological studies (comorbid disorders, risk factors), early diagnosis, classification, and evidence-based therapeutic interventions (psychopharmacology, early intervention, group-based behavioural interventions). Intensive research over the last years has led to a better understanding of, and improved therapeutic options for, autism spectrum disorders.
1 citations
Patent•
26 Sep 2013
TL;DR: In this article, a therapeutic agent for the treatment of toxemia, preeclampsia and eclampia and a method for preparing the therapeutic agent is disclosed. But, the method of using the presence of chymotrypsin in the maternal GI tract as a biomarker, to determine the likelihood of developing a pregnancy induced hypertension, eclampsias/toxemia is not discussed.
Abstract: A therapeutic agent for the treatment of toxemia, preeclampsia and eclampsia and a method for preparing the therapeutic agent are disclosed. The therapeutic agent is a stable pharmaceutical preparation containing, but not limited to, digestive/pancreatic enzymes. The therapeutic agent may be manufactured by a variety of encapsulation technologies. Delivery of the therapeutic agent may be made orally, through injection, by adherence of a medicated patch or by other methods. Further, a method of using the presence of chymotrypsin in the maternal GI tract as a biomarker, to determine the likelihood of developing preeclampsia, a pregnancy induced hypertension, and eclampsia/toxemia is disclosed.
1 citations
Patent•
17 Jun 2016
TL;DR: In this paper, a therapeutic agent for the treatment of toxemia, preeclampsia and eclampia and a method for preparing the therapeutic agent is disclosed. But, the method of using the presence of chymotrypsin in the maternal GI tract as a biomarker, to determine the likelihood of developing a pregnancy induced hypertension, eclampsias/toxemia is not discussed.
Abstract: A therapeutic agent for the treatment of toxemia, preeclampsia and eclampsia and a method for preparing the therapeutic agent are disclosed. The therapeutic agent is a stable pharmaceutical preparation containing, but not limited to, digestive/pancreatic enzymes. The therapeutic agent may be manufactured by a variety of encapsulation technologies. Delivery of the therapeutic agent may be made orally, through injection, by adherence of a medicated patch or by other methods. Further, a method of using the presence of chymotrypsin in the maternal GI tract as a biomarker, to determine the likelihood of developing preeclampsia, a pregnancy induced hypertension, and eclampsia/toxemia is disclosed.
01 Sep 2017
TL;DR: The rationale for managing symptoms of ASD through diet, the current status of research on diet and ASD, and the future of employing this approach to manage ASD are summarized.
Abstract: The frequent presence of gastrointestinal problems in Autistic Spectrum Disorder (ASD) has led to attempts to understand how gastrointestinal disturbances relate to behaviour, and how modifying diets may help to modify behaviour. This review paper aims to summarise the rationale for managing symptoms of ASD through diet, the current status of research on diet and ASD, and the future of employing this approach to manage ASD. School of Clinical Medicine, Cambridge University *Corresponding author: im409@cam.ac.uk
Cites background from "Intravenous secretin for autism spe..."
...Individual case studies report significant improvements in ASD traits following the use of secretin, but larger studies suggest it has no greater effect than placebo [17]....
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...There is also some mixed evidence that administering a synthetic form of secretin, a hormone produced normally by the pancreas, can act to breakdown these peptides, thereby reducing opioid excess, thus improving function in children with ASD [17]....
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01 Jan 2008
TL;DR: The aim of each umbrella review is to focus on the treatment question, "which treatment should I use for this condition?" as discussed by the authors, which is a regular feature of this journal.
Abstract: Editors’ note: Umbrella reviews, compiling evidence from multiple Cochrane reviews into one accessible and usable document, are a regular feature of this journal. Our aim for each umbrella review is to focus on the treatment question, ‘which treatment should I use for this condition?’. It is our hope that the umbrella review will serve as a ‘friendly front end’ to The Cochrane Library, allowing the reader a quick overview (and an exhaustive list) of Cochrane reviews relevant to the clinical decision at hand. Background Description of the condition Autism Spectrum Disorders (ASD) are life-long neurodevelopmental disorders characterized by impairment in reciprocal social interactions, impairment in verbal and non-verbal communication skills, and restricted repetitive and stereotyped patterns of behaviour, interests and activities (American Psychiatric Association, 2000). The spectrum includes conditions such as Autistic Disorder (AD), Asperger syndrome, Atypical Autism, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). As well, many individuals affected by autism have additional diagnoses, most often intellectual impairment but also other physical, behavioural and emotional problems. Current practice requires that autism and related disorders are diagnosed using either the Diagnostic and Statistical Manual of Mental Disorders (DSM) (1) or the International Classification of Diseases (ICD) (2) classification systems. The reported prevalence of ASD has increased in the past 15 to 20 years. Possible explanations are that the incidence of ASD has increased or, alternatively, that the increase represents changes in diagnostic tools, service availability and awareness of ASD among health professionals and the general public. Current estimations of prevalence of Autistic Disorder vary between 10‐15/10,000 children (3), but
References
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TL;DR: Funnel plots, plots of the trials' effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials.
Abstract: Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews . Main outcome measure: Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. Results: In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. Conclusions: A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution. Key messages Systematic reviews of randomised trials are the best strategy for appraising evidence; however, the findings of some meta-analyses were later contradicted by large trials Funnel plots, plots of the trials9 effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials Funnel plot asymmetry was found in 38% of meta-analyses published in leading general medicine journals and in 13% of reviews from the Cochrane Database of Systematic Reviews Critical examination of systematic reviews for publication and related biases should be considered a routine procedure
37,989 citations
TL;DR: It is concluded that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity, and one or both should be presented in publishedMeta-an analyses in preference to the test for heterogeneity.
Abstract: The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
25,460 citations
Book•
23 Sep 2019TL;DR: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
Abstract: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
21,235 citations
Book•
01 Jun 1991
12,618 citations
"Intravenous secretin for autism spe..." refers background in this paper
...Behaviour scales (for example, the Child Behavior Checklist (Achenbach 1991)) 5....
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