Secretin should not be used to treat autism spectrum disorders

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In 1998 a very small study was published, involving just 3 children with autism, who were treated with a hormone called secretin that controls digestion.

Here’s the abstract of the study by Horvath et al:

We report three children with autistic spectrum disorders who underwent upper gastrointestinal endoscopy and intravenous administration of secretin to stimulate pancreaticobiliary secretion. All three had an increased pancreaticobiliary secretory response when compared with nonautistic patients (7.5 to 10 mL/min versus 1 to 2 mL/min). Within 5 weeks of the secretin infusion, a significant amelioration of the children’s gastroinstestinal symptoms was observed, as was a dramatic improvement in their behavior, manifested by improved eye contact, alertness, and expansion of expressive language. These clinical observations suggest an association between gastrointestinal and brain function in patients with autistic behavior.

This article generated some press interested at the time and as a result a number of parents of children with autism contacted their doctors to ask about the treatment.

A Cochrane systematic review was published on this topic in 2005 and this review has now been updated to include 16 randomised controlled trials that explore whether intravenous secretin improves the core features of autism spectrum disorders.

Not only does this review show that secretin is not an effective treatment for autism spectrum disorders, it also stresses that further research of this treatment for this group of patients cannot be justified.

The findings show that the quality of the research in this area is extremely poor:

  • The RCTs showed no improvement in the core features of autism spectrum disorders
  • 900 children were recruited for the trials
  • 25 different outcome measures were used to assess communication, behaviour, visuospatial skills, affect and side effects
  • Outcomes were reported at 3-5 weeks
  • Meta-analysis of the data was impossible because there was such inconsistency in the findings

The reviewers concluded:

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 (autism spectrum disorders).

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.

Links

Horvath K,* Stefanatos G, Sokolski KN, Wachtel R, Nabors L, and Tildon JT. Improved social and language skills after secretin administration in patients with autistic spectrum disorders. Journal of the Association for Academic Minority Physicians 1998; 9:9-15. [PubMed abstract]

Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD003495. DOI: 10.1002/14651858.CD003495.pub3.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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