Articlegreen2018

Treatments for bulimia nervosa: a network meta-analysis

Eric Slade · Ifigeneia Mavranezouli · Glenn Waller · Lucy Serpell · Tim Kendall

81 citations0/0 files storedPsychological Medicine

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

BACKGROUND: Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults. METHODS: A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment. RESULTS: We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19-14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51-10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence. CONCLUSIONS: The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

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References

2009Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement 2011GRADE guidelines: 3. Rating the quality of evidence 2004What to add to nothing? Use and avoidance of continuity corrections in meta‐analysis of sparse data 2003Eating disorders 2012Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women.2013Evidence Synthesis for Decision Making 4 2000A Multicenter Comparison of Cognitive-Behavioral Therapy and Interpersonal Psychotherapy for Bulimia Nervosa 2007Bulimia nervosa treatment: A systematic review of randomized controlled trials

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