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

Abstract

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.

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…Interest in pharmacological approaches is starting to increase, as summarised in a recent review [129]. There is mixed evidence for the use of antipsychotic medications to treat AN [130], although a recent multicenter outpatient study of olanzapine found small positive effects on agitation and weight gain (albeit with no difference in rates of hospitalisation) [131]. The field may need to consider using drugs that have been shown to have benefit in OCD.…”

Psychopharmacological advances in eating disorders

“…The atypical antipsychotic olanzapine, an antagonist at serotonin and dopamine receptors, is of interest as a treatment option for AN [26][27][28][29][30][31]113]. It has been reported to lead to weight gain in patients with schizophrenia [114] on the basis of its high affinity towards the histaminergic H1 receptor and its antihistaminergic action [115].…”

“…According to the mentioned current review to identify recent developments in the pharmacotherapy of eating disorders [30] and a recent meta-analysis [113], olanzapine is the most promising drug for patients with AN, because with regard to weight gain it was superior to placebo in four published RCTs [26][27][28][29], and in a not yet published but recently completed large, multisite RCT in patients with anorexia nervosa performed by Attia et al [30]. In these studies, body weight gain was the major outcome measure.…”

Treatment strategies for the female athlete triad in the adolescent athlete: current perspectives

“…There is no evidence that selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, or antipsychotics are effective in treating AN 49,50. However, a Cochrane review in 2003 found that antidepressant agents were effective for the treatment of BN compared to placebo 51.…”