Treatment characteristics among patients with binge-eating disorder: an electronic health records analysis

ABSTRACT

Objectives

Treatment for adults diagnosed with binge-eating disorder (BED) includes psychotherapy and/or pharmacotherapy and aims to reduce the frequency of binge-eating episodes and disordered eating, improve metabolic-related issues and reduce weight, and address mood symptoms. Data describing real-world treatment patterns are lacking; therefore, this study aims to characterize real-world treatment patterns among patients with BED.

Methods

This retrospective study identified adult patients with BED using natural language processing of clinical notes from the Optum electronic health record database from 2009 to 2015. Treatment patterns were examined during the 12 months preceding the BED recognition date and during a follow-up period after BED recognition (1–3 years for most patients).

Results

Among 1042 patients, 384 were categorized as the BED cohort and 658, who met less stringent criteria, were categorized as probable BED. In the BED cohort, mean ± SD age was 45.2 ± 13.4 years and 81.8% were women (probable BED, 45.9 ± 12.8 years, 80.2%). A greater percentage of patients in the BED cohort were prescribed pharmacotherapy (70.6% [probable BED, 66.9%]) than received/discussed psychotherapy (53.1% [probable BED, 39.2%]) at baseline. In the BED cohort, 54.4% of patients were prescribed antidepressants (probable BED, 52.4%), 25.3% stimulants (probable BED, 20.1%), and 34.4% nonspecific psychotherapy (probable BED, 24.6%) at baseline, with no substantive differences observed during follow-up. Low percentages of patients in the BED cohort received/discussed cognitive behavioral therapy at baseline (12.5% [probable BED, 9.0%) or during follow-up (13.0% [probable BED, 8.8%). Among patients with ≥1 psychotherapy visit, the mean ± SD number of visits in the BED cohort was 1.2 ± 5.9 at baseline (probable BED, 1.7 ± 7.3) and 2.2 ± 7.7 during follow-up (probable BED, 2.6 ± 7.7).

Conclusion

This cohort of patients with BED was treated more frequently with pharmacotherapy than psychotherapy. These data may help inform strategies for reducing differences between real-world treatment patterns and evidence-based recommendations.

KEYWORDS:

• Adult
• behavior therapy
• binge-eating disorder
• comorbidities
• pharmacotherapy
• psychotherapy

List of Abbreviations

Acknowledgments

Under direction of the authors, writing assistance was provided by Srividya Ramachandran, PhD, and Craig Slawecki, PhD, employees of ICON (North Wales, PA, USA). Shire Development LLC, a member of the Takeda group of companies, Lexington, MA, USA provided funding to ICON for support in writing and editing this manuscript.

Declaration of funding

This research was funded by Shire Development LLC, a member of the Takeda group of companies, Lexington, MA, USA.

Disclosure of financial/other conflicts of interest

WMS is an employee of Shire, a member of the Takeda group of companies, and holds Takeda stock. MLB is an employee of Optum (a UnitedHealth Group company), which was funded to conduct this study by Shire, a member of the Takeda group of companies. CMB is a grant recipient and advisory board member for Shire, a consultant for Idorsia, and an author for Pearson. She received money from Shire Pharmaceuticals LLC, a member of the Takeda group of companies, for work that is not part of the current manuscript, including for activities that may include consulting, service on advisory boards, and giving speeches. JDS is an employee of Optum (a UnitedHealth Group company), which was funded to conduct this study by Shire, a member of the Takeda group of companies, and owns UnitedHealth Group company stock and/or stock options. The authors have no other relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declarations

Ethics Approval and Consent to Participate

The protocol was reviewed by an Optum ethics review committee to assure the data could not be used to reidentify patients. Because the analyses used deidentified data, an institutional review board review was not required and informed consent was not required to be obtained from patients. All study procedures followed the principles outlined in the Declaration of Helsinki.

Data Availability Statement

The data that support the findings of this study are available from Optum (Boston, MA, USA) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Optum (Boston, MA, USA).

Author Contributions

WMS, CMB, and JDS contributed to the design of the study and the interpretation of the data. MLB contributed to the design of the study, the data analysis, and the interpretation of the data. All authors participated in manuscript preparation, provided critical review of each draft, read and approved the final manuscript, and made the decision to submit to Postgraduate Medicine.

Supplemental data

Supplemental data for this article can be accessed here