Gabriel P A Costa, Beatriz R Assunção, Renata Belfort-DeAguiar, Julio C Nunes
{"title":"暴食症的药物治疗：系统回顾和网络荟萃分析。","authors":"Gabriel P A Costa, Beatriz R Assunção, Renata Belfort-DeAguiar, Julio C Nunes","doi":"10.1111/obr.13936","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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><p><strong>Methods: </strong>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<sup>2</sup>, Tau-squared (τ<sup>2</sup>), and Cochrane's Q χ<sup>2</sup> tests. Risk of bias was assessed using RoB2 Tool.</p><p><strong>Results: </strong>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><p><strong>Conclusion: </strong>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>","PeriodicalId":216,"journal":{"name":"Obesity Reviews","volume":" ","pages":"e13936"},"PeriodicalIF":8.0000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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\":\"<p><strong>Introduction: </strong>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><p><strong>Methods: </strong>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<sup>2</sup>, Tau-squared (τ<sup>2</sup>), and Cochrane's Q χ<sup>2</sup> tests. Risk of bias was assessed using RoB2 Tool.</p><p><strong>Results: </strong>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><p><strong>Conclusion: </strong>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>\",\"PeriodicalId\":216,\"journal\":{\"name\":\"Obesity Reviews\",\"volume\":\" \",\"pages\":\"e13936\"},\"PeriodicalIF\":8.0000,\"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://doi.org/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}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obesity Reviews","FirstCategoryId":"3","ListUrlMain":"https://doi.org/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}
Pharmacotherapies for Binge Eating Disorder: Systematic Review and Network Meta-Analysis.
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.
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.
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