TY - JOUR
T1 - Psychopharmacology of eating disorders
T2 - Systematic review and meta-analysis of randomized controlled trials
AU - Fornaro, Michele
AU - Mondin, Anna Maria
AU - Billeci, Martina
AU - Fusco, Andrea
AU - De Prisco, Michele
AU - Caiazza, Claudio
AU - Micanti, Fausta
AU - Calati, Raffaella
AU - Carvalho, André Férrer
AU - de Bartolomeis, Andrea
N1 - Publisher Copyright:
© 2023
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: The concurrent assessment of weight and affective psychopathology outcomes relevant to the psychopharmacology of major eating disorders (EDs), namely anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), warrants systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: PubMed, Scopus, and ClinicalTrials.gov were inquired from inception through August 31st, 2022, for RCTs documenting any psychopharmacological intervention for EDs diagnosed according to validated criteria and reporting weight and psychopathology changes. Adopted keywords were: “anorexia nervosa,” “bulimia nervosa,” “binge eating disorder,” “antidepressant,” “antipsychotic,” and “mood stabilizer.” No language restriction applied. Results: 5122 records were identified, and 203 full-texts were reviewed. Sixty-two studies entered the qualitative synthesis (AN = 22, BN = 23, BED = 17), of which 22 entered the meta-analysis (AN = 9, BN = 10, BED = 3). Concerning BMI increase in AN, olanzapine outperformed placebo (Hedges'g = 0.283, 95%C·I. = 0.051–0.515, I2 = 0 %; p =.017), whereas fluoxetine failed (Hedges'g = 0.351, 95%C.I. = −0.248 to 0.95, I2 = 63.37 %; p =.251). Fluoxetine not significantly changed weight (Hedges'g = 0.147, 95%C.I. = −0.157–0.451, I2 = 0 %; p =.343), reducing binging (Hedges'g = 0.203, 95%C.I. = 0.007–0.399, I2 = 0 %; p =.042), and purging episodes (Hedges'g = 0.328, 95%C.I. = −0.061–0.717, I2 = 58.97 %; p =.099) in BN. Lisdexamfetamine reduced weight (Hedges'g = 0.259, 95%C.I. = 0.071–0.446, I2 = 0 %; p =.007) and binging (Hedges'g = 0.571, 95%C.I. = 0.282–0.860, I2 = 53.84 %; p <.001) in BED. Limitations: Small sample size, short duration, and lack of reliable operational definitions affect most of the included sponsored RCTs. Conclusions: The efficacy of different drugs varies across different EDs, warranting additional primary studies recording broad psychopathological and cardiometabolic outcomes besides weight, especially against established psychotherapy interventions.
AB - Background: The concurrent assessment of weight and affective psychopathology outcomes relevant to the psychopharmacology of major eating disorders (EDs), namely anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), warrants systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: PubMed, Scopus, and ClinicalTrials.gov were inquired from inception through August 31st, 2022, for RCTs documenting any psychopharmacological intervention for EDs diagnosed according to validated criteria and reporting weight and psychopathology changes. Adopted keywords were: “anorexia nervosa,” “bulimia nervosa,” “binge eating disorder,” “antidepressant,” “antipsychotic,” and “mood stabilizer.” No language restriction applied. Results: 5122 records were identified, and 203 full-texts were reviewed. Sixty-two studies entered the qualitative synthesis (AN = 22, BN = 23, BED = 17), of which 22 entered the meta-analysis (AN = 9, BN = 10, BED = 3). Concerning BMI increase in AN, olanzapine outperformed placebo (Hedges'g = 0.283, 95%C·I. = 0.051–0.515, I2 = 0 %; p =.017), whereas fluoxetine failed (Hedges'g = 0.351, 95%C.I. = −0.248 to 0.95, I2 = 63.37 %; p =.251). Fluoxetine not significantly changed weight (Hedges'g = 0.147, 95%C.I. = −0.157–0.451, I2 = 0 %; p =.343), reducing binging (Hedges'g = 0.203, 95%C.I. = 0.007–0.399, I2 = 0 %; p =.042), and purging episodes (Hedges'g = 0.328, 95%C.I. = −0.061–0.717, I2 = 58.97 %; p =.099) in BN. Lisdexamfetamine reduced weight (Hedges'g = 0.259, 95%C.I. = 0.071–0.446, I2 = 0 %; p =.007) and binging (Hedges'g = 0.571, 95%C.I. = 0.282–0.860, I2 = 53.84 %; p <.001) in BED. Limitations: Small sample size, short duration, and lack of reliable operational definitions affect most of the included sponsored RCTs. Conclusions: The efficacy of different drugs varies across different EDs, warranting additional primary studies recording broad psychopathological and cardiometabolic outcomes besides weight, especially against established psychotherapy interventions.
KW - Anorexia nervosa
KW - Binge eating disorder
KW - Bulimia nervosa
KW - Psychopharmacology
KW - Systematic review
KW - meta-analysis
UR - https://www.scopus.com/pages/publications/85163825210
U2 - 10.1016/j.jad.2023.06.068
DO - 10.1016/j.jad.2023.06.068
M3 - Review article
C2 - 37393954
AN - SCOPUS:85163825210
SN - 0165-0327
VL - 338
SP - 526
EP - 545
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -