• Kimberly A Brownley, Nancy D Berkman, Christine M Peat, Kathleen N Lohr, Katherine E Cullen, Carla M Bann, and Cynthia M Bulik.
• From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; RTI International, Research Triangle Park, North Carolina; and Karolinska Institutet, Stockholm, Sweden.
• Ann. Intern. Med. 2016 Sep 20; 165 (6): 409420409-20.

BackgroundThe best treatment options for binge-eating disorder are unclear.PurposeTo summarize evidence about the benefits and harms of psychological and pharmacologic therapies for adults with binge-eating disorder.Data SourcesEnglish-language publications in EMBASE, the Cochrane Library, Academic OneFile, CINAHL, and ClinicalTrials.gov through 18 November 2015, and in MEDLINE through 12 May 2016.Study Selection9 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.Data Extraction2 reviewers independently extracted trial data, assessed risk of bias, and graded strength of evidence.Data SynthesisTherapist-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.LimitationsMost 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.ConclusionCognitive behavioral therapy, lisdexamfetamine, SGAs, and topiramate reduced binge eating and related psychopathology, and lisdexamfetamine and topiramate reduced weight in adults with binge-eating disorder.Primary Funding SourceAgency for Healthcare Research and Quality.

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