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. 2022 Nov:142:104857.
doi: 10.1016/j.neubiorev.2022.104857. Epub 2022 Sep 6.

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

Alessio Maria Monteleone  1 , Francesca Pellegrino  2 , Giovanni Croatto  3 , Marco Carfagno  2 , Anja Hilbert  4 , Janet Treasure  5 , Tracey Wade  6 , Cynthia M Bulik  7 , Stephan Zipfel  8 , Phillipa Hay  9 , Ulrike Schmidt  5 , Giovanni Castellini  10 , Angela Favaro  3 , Fernando Fernandez-Aranda  11 , Jae Il Shin  12 , Ulrich Voderholzer  13 , Valdo Ricca  10 , Davide Moretti  10 , Daniele Busatta  10 , Giovanni Abbate-Daga  14 , Filippo Ciullini  15 , Giammarco Cascino  16 , Francesco Monaco  17 , Christoph U Correll  18 , Marco Solmi  19
Affiliations

Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses

Alessio Maria Monteleone et al. Neurosci Biobehav Rev. 2022 Nov.

Abstract

MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults).

Keywords: Eating disorders; Psychopharmacology; Psychotherapy; Randomized controlled trials; Treatment; Umbrella review.

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Conflict of interest statement

Conflicts of interest CMB reports: Shire (grant recipient, Scientific Advisory Board member); Idorsia (consultant); Lundbeckfonden (grant recipient); Pearson (author, royalty recipient); Equip Health Inc. (clinical advisory board). PH receives/has received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, Biomed Central and PlosMedicine and she has received research grants from the NHMRC and ARC. She is Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2019-) and was Member of the ICD-11 Working Group for Eating Disorders (2012–2018) and was Chair Clinical Practice Guidelines Project Working Group (Eating Disorders) of RANZCP (2012–2015). She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals in regards to Binge Eating Disorder (July 2017) and is a consultant to Takeda Pharmacueticals. All views in this paper are her own. SZ is involved in editorial duties by Elsevier, Wiley, Thieme and Frontiers; he received several grants from the German Federal Ministry of Education and Research (e.g. 01GV0624). FFA received consultancy honoraria from Novo Nordisk and editorial honoraria as EIC from Wiley, and he received several national and international Grants (FIS-ISCIII and EU-H2020). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. AH received: royalties for books on the treatment of binge-eating disorder and obesity with Hogrefe; honoraria for workshops and lectures on binge-eating disorder and obesity and their treatment; honoraria as associate editor of the International Journal of Eating Disorders and Psychotherapeut; honoraria as a reviewer from Mercator Research Center Ruhr, Oxford University Press, and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers and Zweites Deutsches Fernsehen. CUC has been a consultant and/or advisor to or has received honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sequirus Sumitomo Dainippon, Sunovion, Supernus, Takeda, Teva and Viatris. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. MS has received honoraria/has been a consultant for Angelini, Lundbeck, unrelated to this work. Other authors have nothing to declare and report no financial relationships with commercial interests.

Figures

Fig. 1.
Fig. 1.
PRISMA 2020 study selection flow diagram.
Fig. 2.
Fig. 2.
Forest plot of interventions with evidence of efficacy in eating disorders. Results are presented as SMD (ES; CI), ordered by control condition, and by magnitude within the control condition. In forest plot, in black comparisons against Active control, in grey against TAU. Legend: 3WPT, third wave psychotherapies; A, Active control; AC, anticonvulsants; AD, mixed antidepressants; ADU, adults; BEHAV, eating disorder behaviours; BT, behavioural therapy; CBT-ED, cognitive behavioural therapy for eating disorders; CI, confidence interval; EDP, eating disorder psychopathology; ES, effect size; FAM, family therapy; FBT, family-based treatment; g, group therapy; GENSX, general psychiatric symptoms; GLOBAL, response/remission/relapse; HOR, hormones; i, individual therapy; LDX, lisdexamfetamine; MIX, mixed age group; ORL, orlistat; P, placebo; SGAD, second generation antidepressants; SMD, standardized mean difference; SSRI, selective serotonin reuptake inhibitors; T, treatment as usual; TCA, tricyclic antidepressants; TOP, topiramate; WEIGHT/BODY, change in weight or body composition
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