Olanzapine <i>versus</i> placebo for out-patients with anorexia nervosa

Attia, Evelyn; Kaplan, Allan S.; Walsh, B. Timothy; Gershkovich, Marina; Yılmaz, Zeynep; Musante, Danila S.; Wang, Y.

doi:10.1017/s0033291711000390

Cited by 100 publications

(88 citation statements)

References 16 publications

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“…There is no evidence to suggest that pharmacotherapy in AN should be first line, but it may play a role in individual patients resistant to treatment or with premorbid psychiatric conditions. 107,[128][129][130] In BN, several RCTs in adults have found that antidepressants are effective in decreasing binge eating and purging symptoms. Specifically, fluoxetine has a strong evidence base and is approved by the Food and Drug Administration for use in adults with BN; thus far there is some evidence that the effects are similar in adolescents.…”

Section: Pharmacotherapymentioning

confidence: 99%

Eating Disorders in Children and Adolescents: State of the Art Review

2014

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This is the 3rd in our series on Adolescent Health. abstract Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.

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Section: Pharmacotherapymentioning

confidence: 99%

Eating Disorders in Children and Adolescents: State of the Art Review

2014

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“…The updated literature search yielded 698 citations in the initial search step and finally, six citations on four trials were incorporated [31,32,33,34]. Online supplementary figure 1 (see www.karger.com/doi/10.1159/000369978 for all online suppl.…”

Section: Resultsmentioning

confidence: 99%

“…In those studies indicating the subtype of anorexia nervosa 64.2% suffered from the restricting subtype and the remaining ones from the binge-purging subtype. Four trials examined an antipsychotic medication with olanzapine (n = 112) [28,29,31,33], two with quetiapine (n = 48) [30,34], and one with risperidone (n = 41) [32]. All studies were characterized by a parallel-group design.…”

Section: Resultsmentioning

confidence: 99%

“…One study was nonblinded [30] whereas the remaining trials used a double-blind design. The number of participants in each study ranged from 15 [34] to 41 [32] (mean ± SD: 28.7 ± 9.43) and trial duration varied between 8 [31,34] and 12 weeks [28,30] (mean ± SD: 10.1 ± 1.7 weeks). The mean age of patients was 24.1 ± 6.3 years and under 18 years of age in two trials [32,33].…”

Section: Resultsmentioning

confidence: 99%

“…The mean (±SD) BMI at baseline was 16.3 ± 0.5 kg/m 2 . One RCT included only day hospital patients [29], two exclusively outpatients [28,31], and the remaining ones comprised various settings. In five studies, participants had to attend a background eating disorder program containing standardized psychotherapeutic and/or psychosocial interventions [28,29,30,32,33].…”

Section: Resultsmentioning

confidence: 99%

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Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials

Dold

Anders

Klabunde

et al. 2015

Psychother Psychosom

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Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the ‘World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option.

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