EXPERT ANALYSIS AT THE ANNUAL ADVANCES IN INTERNAL MEDICINE

SAN FRANCISCO (FRONTLINE MEDICAL NEWS) – For patients who meet criteria for binge eating and who express a desire to lose weight, topiramate or lisdexamfetamine are effective treatment options, according to Judith Walsh, MD.

“Binge eating is the most common eating disorder in the United States,” Dr. Walsh said at the UCSF Annual Advances in Internal Medicine meeting. “The lifetime prevalence is 3.5% in women, compared with 2% in men, and 5%-30% of affected women are obese.”

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the condition is characterized by binge eating episodes during which patients consume larger amounts of food than most people would under similar circumstances. “They feel a lack control over eating, [the notion that] ‘I’m eating and I can’t stop,’” said Dr. Walsh of the UCSF division of internal medicine and the Women’s Center for Excellence. Affected patients engage in the behavior of binge eating more than once per week over a period of at least 3 months, and the episodes typically last fewer than 2 hours.

While therapist-led cognitive-behavioral therapy (CBT) is generally considered to be the mainstay of treatment for binge eating disorder, guidelines from the American Psychiatric Association and the National Institute for Health and Care Excellence are conflicting, she said.

A recent meta-analysis funded by the Agency for Healthcare Research and Quality set out to summarize the benefits and harms of psychological and pharmacologic therapies for adults with binge eating disorder ( Ann Intern Med. 2016 Sep 20;165[6]:409-20 ). The researchers evaluated 34 published trials with a low to medium risk of bias, including 25 placebo-controlled trials and 9 waitlist-controlled psychological trials. The majority of trial participants (77%) were women, their mean body mass index was 28.8 kg/m2, and their treatment duration ranged from 6 weeks to 6 months.

The review found that second-generation antidepressants such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline improved abstinence from binge eating (relative risk, 1.67) and depression symptoms (RR, 1.97), but resulted in no weight change. Therapist-led CBT was found to strongly improve abstinence from binge eating (RR, 4.95), but it resulted in no change in depressive symptoms or in weight.

Use of lisdexamfetamine was associated with improved abstinence from binge eating (RR, 2.61) and weight loss of 5.2%-6.3%, while use of topiramate was found in two trials to have a moderate benefit on abstinence from binge eating (by 58%-64% in one trial and by 29%-30% in the other), and weight loss of about 4.9 kg.

“Harms of treatment are generally not reported in the psychological studies, nor in 20 of the 25 pharmacologic studies included in the analysis,” said Dr. Walsh, who was not involved with review. The three trials of lisdexamfetamine found an increased risk of sympathetic nervous system arousal (RR, 4.28), insomnia (RR, 2.8), and GI upset (RR, 2.71).

“So, in adults with binge eating disorder, the primary therapy to increase abstinence is cognitive-behavioral therapy, topiramate, lisdexamfetamine, and second-generation antidepressants,” Dr. Walsh concluded. If reducing weight is a priority, the best available treatment options are topiramate and lisdexamfetamine, she said.

Dr. Walsh reported having no financial disclosures.

dbrunk@frontlinemedcom.com

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