Pharmacotherapeutic strategies for treating binge eating disorder. Evidence from clinical trials and implications for clinical practice

ABSTRACT

Introduction: Binge eating disorder (BED) is the most common eating disorder and was newly recognized in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). BED is frequently associated with obesity and the metabolic syndrome, as well as with other psychiatric diseases, such as mood (49%), anxiety (41%), and substance use (22%) disorders. BED is highly prevalent and carries a high burden of mental and physical illness and disability. However, BED is frequently under-recognized and under-treated.

Areas covered: This paper reviews the main pharmacological treatments for BED and provides an expert opinion based on the available evidence and on the authors’ clinical experience with patients affected by BED.

Expert opinion: Several medications have proven to be effective for the treatment of BED, including Lisdexamfetamine (LDX), topiramate as well as anti-anxiety and antidepressant medications. To date, LDX is the only FDA approved medication for BED. Consequently, as a general rule, the use of an FDA approved medication should always be preferred. However, when in the presence of concomitant psychiatric conditions such as anxiety or depression, other medications that have proven efficacy in those comorbid conditions can be used and may contextually provide a benefit for BED.

KEYWORDS:

• Binge eating disorder
• pharmacotherapeutic strategies
• treatment
• lisdexamfetamine
• antidepressants
• anticonvulsants
• obesity agents
• expert opinion

Article highlights

• Binge Eating Disorder (BED) is a prevalent, yet underdiagnosed and undertreated condition.

• International guidelines suggest psychological and behavioral therapy as first-line treatment approach for BED.

• Lisdexamfetamine (LDX) has been approved in the USA and Canada as the first on-label treatment for BED.

• Off-label medications, including antidepressants of all classes, anticonvulsants and anti-obesity agents, have been used as well.

• The available evidence about in-label and off-label pharmacological treatments for BED is described and discussed.

This box summarizes key points contained in the article.

Declaration of interest

A Fagiolini is or has been a consultant and/or a speaker and/or has received research funding in the form of grants from Allergan, Angelini, Apsen Farmaceutica, Boehringer Ingelheim, Doc Generici, FB Health SpA, Italfarmaco, Janssen Pharmaceuticals, Lundbeck A/S, Mylan, Otsuka Pharmaceutical Co. Ltd., Pfizer Inc, Recordati S.p.A., Sanofi, Sunovion and Vifor. A Cuomo is or has been a consultant and/or speaker for Angelini, Janssen Pharmaceuticals, Lundbeck and Otsuka Pharmaceutical Co. Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.