Pharmacotherapies for Binge Eating Disorder: Systematic Review and Network Meta-Analysis

IF 7.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Obesity Reviews Pub Date : 2025-05-08 DOI:10.1111/obr.13936

Gabriel P. A. Costa, Beatriz R. Assunção, Renata Belfort-DeAguiar, Julio C. Nunes

{"title":"Pharmacotherapies for Binge Eating Disorder: Systematic Review and Network Meta-Analysis","authors":"Gabriel P. A. Costa, Beatriz R. Assunção, Renata Belfort-DeAguiar, Julio C. Nunes","doi":"10.1111/obr.13936","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Binge eating disorder (BED) is a psychiatric diagnosis involving recurrent episodes of compulsive overeating followed by ensuing distress. Despite its significant impact on mental and physical health, pharmacological treatment options remain limited. We present the first network meta-analysis synthetizing evidence on the efficacy, safety, and tolerability of pharmacological interventions for BED.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A systematic search across PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, and LILACS was conducted to identify randomized controlled trials assessing pharmacological-only interventions for adults with BED. Outcomes included reduction in binge-eating episode frequency, changes from baseline in weight, BMI, and eating disorder scores, along with remission rates, medication discontinuation rates, and adverse events. The DerSimonian-Laird random-effects model was employed to estimate the overall effect size across studies. Heterogeneity was estimated using <i>I</i><sup>2</sup>, Tau-squared (<i>τ</i><sup>2</sup>), and Cochrane's Q <i>χ</i><sup>2</sup> tests. Risk of bias was assessed using RoB2 Tool.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among findings with high-certainty evidence, topiramate showed the greatest efficacy for reducing binge-eating episodes (mean difference [MD] = −1.72) and promoting remission (odds ratio [OR] = 3.99), followed by lisdexamfetamine (MD = −1.50; OR = 3.33) and dasotraline (MD = −0.97; OR = 1.97). Lisdexamfetamine had the highest odds of adverse events, including anxiety, insomnia, diarrhea, and headache. Most studies failed to use validated assessment instruments and inconsistently defined remission periods.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Topiramate, lisdexamfetamine, and dasotraline show significant potential in treating BED. However, the landscape of pharmacotherapy for BED lacks robust evidence and methodological standardization. Larger trials with expanded sample sizes and using validated scales are needed to guide clinical practice for this highly prevalent and damaging disorder.</p>\n </section>\n </div>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":"26 9","pages":""},"PeriodicalIF":7.4000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obesity Reviews","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/obr.13936","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Binge eating disorder (BED) is a psychiatric diagnosis involving recurrent episodes of compulsive overeating followed by ensuing distress. Despite its significant impact on mental and physical health, pharmacological treatment options remain limited. We present the first network meta-analysis synthetizing evidence on the efficacy, safety, and tolerability of pharmacological interventions for BED.

Methods

A systematic search across PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, and LILACS was conducted to identify randomized controlled trials assessing pharmacological-only interventions for adults with BED. Outcomes included reduction in binge-eating episode frequency, changes from baseline in weight, BMI, and eating disorder scores, along with remission rates, medication discontinuation rates, and adverse events. The DerSimonian-Laird random-effects model was employed to estimate the overall effect size across studies. Heterogeneity was estimated using I², Tau-squared (τ²), and Cochrane's Q χ² tests. Risk of bias was assessed using RoB2 Tool.

Results

Among findings with high-certainty evidence, topiramate showed the greatest efficacy for reducing binge-eating episodes (mean difference [MD] = −1.72) and promoting remission (odds ratio [OR] = 3.99), followed by lisdexamfetamine (MD = −1.50; OR = 3.33) and dasotraline (MD = −0.97; OR = 1.97). Lisdexamfetamine had the highest odds of adverse events, including anxiety, insomnia, diarrhea, and headache. Most studies failed to use validated assessment instruments and inconsistently defined remission periods.

Conclusion

Topiramate, lisdexamfetamine, and dasotraline show significant potential in treating BED. However, the landscape of pharmacotherapy for BED lacks robust evidence and methodological standardization. Larger trials with expanded sample sizes and using validated scales are needed to guide clinical practice for this highly prevalent and damaging disorder.

查看原文本刊更多论文

暴食症的药物治疗：系统回顾和网络荟萃分析。

暴饮暴食症（BED）是一种精神病学诊断，包括反复发作的强迫性暴饮暴食以及随之而来的痛苦。尽管它对身心健康有重大影响，但药物治疗选择仍然有限。我们提出了第一个网络荟萃分析，综合了药物干预BED的有效性、安全性和耐受性的证据。方法：系统检索PubMed、Embase、Web of Science、Cochrane Library、PsycINFO和LILACS，以确定评估成人BED仅采用药物干预措施的随机对照试验。结果包括暴食发作频率的减少，体重、BMI和饮食失调评分与基线相比的变化，以及缓解率、药物停药率和不良事件。采用dersimonan - laird随机效应模型估计各研究的总体效应大小。采用I2、τ2和Cochrane’s Q χ2检验估计异质性。使用RoB2工具评估偏倚风险。结果：在具有高确定性证据的研究结果中，托吡酯在减少暴食发作（平均差值[MD] = -1.72）和促进缓解（优势比[OR] = 3.99）方面表现出最大的疗效，其次是利地氨苯他明(MD = -1.50；OR = 3.33)和dasotraline (MD = -0.97；or = 1.97)。利地安非他明的不良事件发生率最高，包括焦虑、失眠、腹泻和头痛。大多数研究未能使用有效的评估工具和不一致的缓解期定义。结论：托吡酯、利地安非他明、达索曲林治疗BED有显著疗效。然而，药物治疗BED的前景缺乏强有力的证据和方法标准化。需要更大规模的试验，扩大样本量，并使用有效的量表来指导这种高度流行和破坏性疾病的临床实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Obesity Reviews 医学-内分泌学与代谢

CiteScore

19.30

自引率

1.10%

发文量

130

审稿时长

1 months

期刊介绍： Obesity Reviews is a monthly journal publishing reviews on all disciplines related to obesity and its comorbidities. This includes basic and behavioral sciences, clinical treatment and outcomes, epidemiology, prevention and public health. The journal should, therefore, appeal to all professionals with an interest in obesity and its comorbidities. Review types may include systematic narrative reviews, quantitative meta-analyses and narrative reviews but all must offer new insights, critical or novel perspectives that will enhance the state of knowledge in the field. The editorial policy is to publish high quality peer-reviewed manuscripts that provide needed new insight into all aspects of obesity and its related comorbidities while minimizing the period between submission and publication.