PMID- 34992243
OWN - NLM
STAT- MEDLINE
DCOM- 20220425
LR  - 20221023
IS  - 1476-5497 (Electronic)
IS  - 0307-0565 (Linking)
VI  - 46
IP  - 4
DP  - 2022 Apr
TI  - What pharmacological interventions are effective in binge-eating disorder? 
      Insights from a critical evaluation of the evidence from clinical trials.
PG  - 677-695
LID - 10.1038/s41366-021-01032-9 [doi]
AB  - Binge-eating disorder (BED) is the commonest eating disorder and an important 
      causal factor in obesity. Lisdexamfetamine is the only approved pharmacological 
      treatment. Many drugs have been clinically evaluated and several were described 
      as potentially promising treatments. A comprehensive reassessment of the evidence 
      from these clinical trials has been performed. The questions to be answered were: 
      (1) Does the evidence support claims of efficacy? (2) What pharmacological 
      mechanisms show promise for developing new BED drugs? (3) What are the clinical 
      implications for treating BED? PubMed and internal database searches identified 
      every available published drug trial in BED. The trials and their results were 
      summarised and reviewed to re-evaluate the evidence. Factors taken into 
      consideration included psychiatric diagnosis, primary endpoint, secondary outcome 
      measures, trial size, blinding and controls, drop-out rates, placebo response 
      rates and weight-loss. Drugs were classified according to their pharmacology and 
      therapeutic indication to determine which mechanisms were effective and to 
      provide insights into the psychopathology of BED. For most drugs, robust evidence 
      of efficacy in BED is insubstantial or absent. Some catecholaminergic drugs 
      developed for ADHD are also effective in BED; other pharmacological mechanisms 
      are weakly efficacious at best. Reducing BED severity has little impact on 
      weight. Conversely, weight-loss from anti-obesity therapy is ineffective in 
      ameliorating the psychopathological drivers of BED. (1) BED is a psychiatric not 
      a metabolic disorder. (2) Weight-loss drugs are generally ineffective in BED. (3) 
      Efficacy in BED is restricted to powerful catecholaminergic drugs. (4) Drugs 
      acting via noradrenaline, 5-HT, GABA, carbonic anhydrase inhibition, opioid 
      receptors and various ion channels are generally minimally effective at best. (5) 
      Efficacy in BED is dependent on treating its core psychopathology; reducing 
      impulsivity and compulsivity and increasing cognitive restraint over eating. (6) 
      Obese subjects with BED may benefit from separate treatments for these two 
      disorders.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer Nature Limited.
FAU - Heal, David J
AU  - Heal DJ
AUID- ORCID: 0000-0002-6128-9632
AD  - DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK. david.heal@develrx.com.
AD  - Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY, UK. 
      david.heal@develrx.com.
FAU - Gosden, Jane
AU  - Gosden J
AD  - DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220107
PL  - England
TA  - Int J Obes (Lond)
JT  - International journal of obesity (2005)
JID - 101256108
RN  - 0 (Anti-Obesity Agents)
SB  - IM
MH  - *Anti-Obesity Agents/pharmacology/therapeutic use
MH  - *Binge-Eating Disorder/drug therapy
MH  - Clinical Trials as Topic
MH  - Humans
MH  - Obesity/complications
MH  - Treatment Outcome
MH  - Weight Loss
EDAT- 2022/01/08 06:00
MHDA- 2022/04/26 06:00
CRDT- 2022/01/07 06:16
PHST- 2020/06/17 00:00 [received]
PHST- 2021/11/18 00:00 [accepted]
PHST- 2021/11/01 00:00 [revised]
PHST- 2022/01/08 06:00 [pubmed]
PHST- 2022/04/26 06:00 [medline]
PHST- 2022/01/07 06:16 [entrez]
AID - 10.1038/s41366-021-01032-9 [pii]
AID - 10.1038/s41366-021-01032-9 [doi]
PST - ppublish
SO  - Int J Obes (Lond). 2022 Apr;46(4):677-695. doi: 10.1038/s41366-021-01032-9. Epub 
      2022 Jan 7.