Review and Meta‐analysis of Pharmacotherapy for Binge‐eating Disorder

Abstract

This study evaluated available controlled treatment studies to determine utility of pharmacotherapy for binge-eating disorder (BED). The authors identified randomized placebo-controlled trials testing pharmacotherapy-only treatments and controlled trials testing pharmacotherapy with psychotherapy treatments. Meta-analysis was performed on placebo-controlled trials with data for attrition, remission, and weight loss. Qualitative review was performed on remaining controlled treatment literature. A total of 33 studies were considered of which 14 studies with a total of 1,279 patients were included in the meta-analysis of pharmacotherapy-only treatment and 8 studies with a total of 683 patients were included in the qualitative review of pharmacotherapy combined with psychotherapy interventions. No evidence suggested significant differences between medication and placebo for attrition. Evidence suggested that pharmacological treatments have a clinically significant advantage over placebo for achieving short-term remission from binge eating (48.7% vs. 28.5%) and for weight loss, although weight losses are not substantial. No data exist to allow evaluation of longer-term effects of pharmacotherapy-only treatment for BED. Combining medications with psychotherapy interventions failed to significantly enhance binge outcomes, although specific medications (orlistat, topiramate) enhanced weight losses achieved with cognitive behavioral therapy and behavioral weight loss. In summary, BED patients can be advised that certain pharmacotherapies may enhance likelihood of stopping binge eating short term, but that longer-term effects are unknown. Although some weight loss may occur, it is unlikely to be substantial with available medications. Combining medications with cognitive or behavioral treatments is unlikely to enhance binge outcomes, but specific medications (orlistat, topiramate) may enhance weight losses, albeit modestly.

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

“…Em estudo metanalítico, Stefano et al concluíram que, de fato, os antidepressivos se mostram superiores ao placebo na redução de episódios de compulsão alimentar nos ensaios de curta duração (média de oito semanas); porém, um estudo com duração de 16 semanas não demonstrou vantagem da medicação sobre o placebo 54 . Os autores concluíram pela ausência de evidência de eficácia em longo prazo no uso de antidepressivos para o controle do TCAP 54,55 . O topiramato mostra-se eficaz na redução de episódios de compulsão alimentar em diversos estudos [56][57][58] .…”

Acamprosate in the treatment of binge eating disorder: A placebo‐controlled trial

“…5 Cognitive behavioral and interpersonal therapies and selective serotonin-reuptake inhibitor (SSRI) antidepressants are effective for reducing binge eating, but usually are not associated with clinically significant weight loss. [6][7][8] Sibutramine, topiramate, zonisamide, atomoxetine, and orlistat are effective for decreasing both binge eating and body weight, but are associated with problematic side effects and relatively high discontinuation rates. [9][10][11][12][13][14][15][16][17] Moreover, a substantial number of patients do not respond adequately to these psychological or pharmacological treatments.…”

Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder

“…3,[14][15][16] Antiepileptics also have been studied for BED, although they are associated with high rates of discontinuation. 3,17,18 The most extensively studied antiepileptic for BED, topiramate, has efficacy in BE and weight loss, but its use is limited by effects on cognition.…”