Kimberly A. Brownley, PhD; Nancy D. Berkman, PhD; Christine M. Peat, PhD; Kathleen N. Lohr, PhD; Katherine E. Cullen, BA; Carla M. Bann, PhD; Cynthia M. Bulik, PhD
Acknowledgment: The authors thank Lauren Breithaupt and Margaret Sala for their assistance with abstract reviews. They acknowledge Isabelle Lanser, Michela Quaranta, Loraine Monroe, Laura Morgan, and Morgan Walker for their assistance with table development and manuscript preparation for this review. For their assistance with the report from which this manuscript was based, the authors also thank Meera Viswanathan, PhD; Ina F. Wallace, PhD; and Lynn Whitener, DrPH, MSLS.
Grant Support: By contract 290-2012-00008-U from AHRQ (all authors) and VR Dnr 538-2013-8864 from the Swedish Research Council (Dr. Bulik).
Disclosures: Dr. Brownley reports grants from the Agency for Healthcare Research and Quality during the conduct of the study, and personal fees from Shire and Sunovion Pharmaceuticals outside the submitted work. Dr. Lohr was an employee of RTI International–University of North Carolina Evidence-Based Practice Center during the conduct of the study; received consulting fees from ECRI Institute outside the submitted work; and is vice president (unpaid) for PROMIS (Patient Reported Outcomes Measurement Information System), a 501(c)(3) foundation to support development and dissemination of patient-reported outcomes measurement systems. Dr. Bulik reports grants from Shire, personal fees from Ironshore, and textbook royalties from Pearson, outside the submitted work. Dr. Peat reports grants from Shire and membership on the BED advisory board of Sunovion Pharmaceuticals. Authors not named here have disclosed no conflicts of interest. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2455.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Available at www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1942. Statistical code and data set: In Methods and Results sections, respectively; full report is available at www.effective healthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2157.
Requests for Single Reprints: Kimberly A. Brownley, PhD, Department of Psychiatry, University of North Carolina, CB #7175, Chapel Hill, NC 27599; e-mail, email@example.com.
Current Author Addresses: Dr. Brownley: Department of Psychiatry, University of North Carolina, CB #7175, Chapel Hill, NC 27599.
Drs. Berkman, Lohr, and Bann and Ms. Cullen: RTI International, PO Box 12194, Research Triangle Park, NC 27709.
Drs. Peat and Bulik: Department of Psychiatry, University of North Carolina, CB #7160, Chapel Hill, NC 27599.
Author Contributions: Conception and design: N.D. Berkman, C.M. Peat, K.E. Cullen, C.M. Bulik.
Analysis and interpretation of the data: K.A. Brownley, N.D. Berkman, C.M. Peat, K.N. Lohr, C.M. Bann, C.M. Bulik.
Drafting of the article: K.A. Brownley, N.D. Berkman, C.M. Peat, K.N. Lohr, K.E. Cullen, C.M. Bann.
Critical revision for important intellectual content: K.A. Brownley, N.D. Berkman, C.M. Peat, K.N. Lohr, C.M. Bulik.
Final approval of the article: K.A. Brownley, N.D. Berkman, C.M. Peat, K.N. Lohr, K.E. Cullen, C.M. Bann, C.M. Bulik.
Statistical expertise: C.M. Bann.
Obtaining of funding: K.A. Brownley, N.D. Berkman, C.M. Peat, K.N. Lohr, C.M. Bulik.
Administrative, technical, or logistic support: N.D. Berkman, K.N. Lohr, K.E. Cullen.
Collection and assembly of data: K.A. Brownley, N.D. Berkman, C.M. Peat, K.E. Cullen, C.M. Bulik.
The best treatment options for binge-eating disorder are unclear.
To summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder.
English-language publications in EMBASE, the Cochrane Library, Academic OneFile, CINAHL, and ClinicalTrials.gov through 18 November 2015, and in MEDLINE through 12 May 2016.
9 waitlist-controlled psychological trials and 25 placebo-controlled trials that evaluated pharmacologic (n = 19) or combination (n = 6) treatment. All were randomized trials with low or medium risk of bias.
2 reviewers independently extracted trial data, assessed risk of bias, and graded strength of evidence.
Therapist-led cognitive behavioral therapy, lisdexamfetamine, and second-generation antidepressants (SGAs) decreased binge-eating frequency and increased binge-eating abstinence (relative risk, 4.95 [95% CI, 3.06 to 8.00], 2.61 [CI, 2.04 to 3.33], and 1.67 [CI, 1.24 to 2.26], respectively). Lisdexamfetamine (mean difference [MD], −6.50 [CI, −8.82 to −4.18]) and SGAs (MD, −3.84 [CI, −6.55 to −1.13]) reduced binge-eating–related obsessions and compulsions, and SGAs reduced symptoms of depression (MD, −1.97 [CI, −3.67 to −0.28]). Headache, gastrointestinal upset, sleep disturbance, and sympathetic nervous system arousal occurred more frequently with lisdexamfetamine than placebo (relative risk range, 1.63 to 4.28). Other forms of cognitive behavioral therapy and topiramate also increased abstinence and reduced binge-eating frequency and related psychopathology. Topiramate reduced weight and increased sympathetic nervous system arousal, and lisdexamfetamine reduced weight and appetite.
Most study participants were overweight or obese white women aged 20 to 40 years. Many treatments were examined only in single studies. Outcomes were measured inconsistently across trials and rarely assessed beyond end of treatment.
Cognitive behavioral therapy, lisdexamfetamine, SGAs, and topiramate reduced binge eating and related psychopathology, and lisdexamfetamine and topiramate reduced weight in adults with binge-eating disorder.
Agency for Healthcare Research and Quality.
Brownley KA, Berkman ND, Peat CM, et al. Binge-Eating Disorder in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2016;165:409–420. [Epub ahead of print 28 June 2016]. doi: https://doi.org/10.7326/M15-2455
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Published: Ann Intern Med. 2016;165(6):409-420.
Published at www.annals.org on 28 June 2016
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