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

Deborah Lynn Reas · Carlos M. Grilo

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Pharmacology and Obesity Treatment

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.

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References

2009Diagnostic and Statistical Manual of Mental Disorders 2001The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials 2006The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication 2001The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials 2001The CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel-Group Randomized Trials 2004Empirical Evidence for Selective Reporting of Outcomes in Randomized Trials 2007Psychological treatment of eating disorders.2003Topiramate in the Treatment of Binge Eating Disorder Associated With Obesity: A Randomized, Placebo-Controlled Trial

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2017Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives 2010Eating disorders, obesity and addiction 2012Psychological Treatments for Binge Eating Disorder 2015Binge-eating disorder diagnosis and treatment: a recap in front of DSM-5 2009

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