Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

Abstract Objective The main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa(BN). Methods Randomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase, from inception to November 2022. Primary outcomes were: changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were difference in the improvement of scores in depressive symptoms; tolerability (dropout due to adverse events) and weight change. Results The literature search ultimately included 11 drugs, 33 studies and 6 types of medicine, 8 trials with TCAs (imipramine, desipramine and amitriptyline), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizer (lithium), 1 with amphetamine-type appetite suppressant (fenfluramine). In the reduction of binge eating episodes was more likely on these drugs than placebo, the SMD was − 0.4 (95% CI -0.61~-0.19); about the changes in the frequency of vomiting episodes (SMD=-0.16, 95% CI -0.3~-0.03); weight (WMD=-3.05, 95% CI -5.97~-0.13); depressive symptoms (SMD=-0.29 ,95% CI -0.48~-0.11). However, no statistical difference was found in dropout due to adverse events (RR = 1.62, 95% CI 0.98 ~ 2.67). Conclusions This meta-analysis indicates that most pharmacotherapies declined the frequency of binge-eating and vomiting episode, body weight, and depressive symptoms in BN patients, but the efficacy is not very significant. In each medicine, the efficacy is not the same, which through different aspects, different symptoms to improve the clinical performance of bulimia nervosa.