Review and meta-analysis of pharmacotherapy for binge-eating disorder

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.

Figure 1

Attrition rate: medication vs. placebo. Pearlstein et al. (15) reported an overall (5/25) 20% dropout rate, but did not specify attrition by group (denoted by an asterisk).

Figure 2

Remission rate: medication vs. placebo.

Figure 3

Weight loss (kg): medication vs. placebo. An asterisk (*) denotes completer data. When possible, missing or unavailable s.d. for change scores (C) were imputed using the general formulas: $\mathrm{s}.\mathrm{d}.\left(C\right)={\sqrt{(\mathrm{s}.\mathrm{d}{.}_{\mathrm{pre}})}}^2\times {(\mathrm{s}.\mathrm{d}{.}_{\mathrm{post}})}^2-(2\times R_1\times \mathrm{s}.\mathrm{d}{.}_{\mathrm{pre}}\times \mathrm{s}.\mathrm{d}{.}_{\mathrm{post}})$. Pounds (lb) were converted to kilograms (kg) by multiplying values by 0.45.