Intravenous secretin for autism spectrum disorder

Williams KJ, Wray JJ, Wheeler DM

Published Online:

January 21, 2009

Secretin is a gastro-intestinal hormone which has been presented as an effective treatment for autism based on anecdotal evidence. This review of thirteen randomised studies found no evidence that single or multiple dose intravenous secretin is effective across a range of outcomes, and concludes that as such it should not currently be recommended or administered as a treatment for autism. Further experimental assessment of secretin's effectiveness for autism can only be justified if methodological problems of existing research can be overcome.

Abstract (click to read)

Background:

Secretin is a gastro-intestinal hormone which has been presented as an effective treatment for autism based on anecdotal evidence.

Objectives:

To determine if intravenous secretin:
1. improves the core features of autism (social interaction, communication and behaviour problems);
2. improves the non-core aspects of behaviour or function such as self injurious behaviour;
3. improves the quality of life of affected individuals and their carers;
4. has short term and long term effects on outcome;
5. causes harm.

Search strategy:

Results of electronic searches of CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, HealthStar and Sociofile (1998 - March 2005) were independently examined by two authors. Reference lists of trials and reviews were searched; experts and trialists were contacted to find unpublished studies.

Selection criteria:

Randomised controlled trials of intravenous secretin comparing secretin with a placebo treatment in children or adults diagnosed with autism spectrum disorders, where at least one standardised outcome measure was reported.

Data collection and analysis:

Fourteen studies met inclusion criteria. All outcome data were continuous. Where trials used cross-over designs, analysis was conducted on results from first treatment phase, allowing combined analysis with parallel design trials. Where standardised assessment tools generated scores as outcome measures, comparisons were made between means of these scores. Where baseline means were reported, differences between treatment and control were determined to assess possible bias. Where mean change from baseline was reported, this was used in preference to post-treatment scores for meta-analyses or forest plots. As meta-analysis was possible for only one outcome (Childhood Autism Rating Scale), it was impossible to use sensitivity or subgroup analyses to assess 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:

Twenty-five established standardised outcome measures were reported to assess core features of autism, communication, behaviour, visio-spatial skills, affect and adverse events within fourteen included studies. No more than four studies used any one outcome measure similarly. Outcomes were reported between three and six weeks. RCTs of efficacy of secretin in autism have not shown improvements for core features of autism.

Authors' conclusions:

There is no evidence that single or multiple dose intravenous secretin is effective and as such it should not currently be recommended or administered as a treatment for autism. Further experimental assessment of secretin's effectiveness for autism can only be justified if methodological problems of existing research can be overcome.

This record should be cited as:

Williams KJ, Wray JJ, Wheeler DM. Intravenous secretin for autism spectrum disorder. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003495. DOI: 10.1002/14651858.CD003495.pub2

Assessed as up to date:

March 24, 2005

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Primary Review Group:

Developmental, Psychosocial and Learning Problems Group

Health topics:

Developmental, psychosocial, and learning problems > Developmental problems > Autistic spectrum disorder

Demographic:

Children

Cochrane group topics:

Developmental, Psychosocial and Learning Problems > DEVELOPMENTAL PROBLEMS > AUTISTIC SPECTRUM DISORDER > Autism