Drug for ADHD shows promise for treating binge eating disorder

A drug approved for the treatment of attention deficit-hyperactivity disorder (ADHD), lisdexamfetamine dimesylate, cuts the number of binge eating days in people with binge eating disorder, according to a study published in JAMA Psychiatry
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There is currently no approved medicine for binge-eating disorder, an eating disorder characterised by recurrent episodes of excessive food consumption, a sense of loss of control and psychological distress, and being overweight or obese.

Guidance from the UK’s National Institute for Health and Care Excellence, published in 2004, recommends that patients follow an evidenced-based self-help programme as a first step or a trial course of a selective serotonin reuptake inhibitor. Patients may also be offered a course of cognitive behavioural therapy (CBT), which has been shown to have an impact on binge eating behaviour, it says.

In this study, researchers from the Lindner Center of HOPE in Mason, Ohio, compared 11 weeks of treatment with 30mg/day, 50mg/day or 70mg/day lisdexamfetamine (marketed at Elvanse in Europe and as Vyvanse in the United States) with placebo in a randomised trial including 260 adults with moderate to severe binge-eating disorder.

The number of binge eating days per week decreased in the 50mg/day and 70 mg/day treatment groups compared with placebo – log-transformed binge eating days per week decreased with the 50-mg/day (least squares [LS] mean [SE] change, −1.49 [0.066]; P = .008) and 70-mg/d (LS mean [SE] change, −1.57 [0.067]; P < .001) but not in the 30 mg/day group (LS mean [SE] change, −1.24 [0.067]; P = .88).

Fewer patients also achieved four-week binge eating cessation in the placebo group (21.3%) compared with the 50 mg/day (42.2%) and 70 mg/day (50%) treatment groups.

Patients who took lisdexamfetamine also lost weight over the 11 weeks: the mean (SD) change in body weight was −3.1kg (3.64) for 30mg/day, −4.9kg (4.43) for 50mg/day, and −4.9kg (3.93) for 70mg/day (P < .001). The weight of patients in the placebo group remained unchanged at −0.1kg (3.09).

The authors say their findings support the need for further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behaviour in adults with moderate to severe binge-eating disorder. “Confirmation of these findings in ongoing clinical trials may result in improved pharmacologic treatment for moderate to severe binge-eating disorder,” they say.

“Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship” was involved, they add, and “the lisdexamfetamine safety profile was generally consistent with findings in adults with ADHD”.

Susan Ringwood, chief executive officer of Beat, the charity that supports and campaigns on behalf of people with eating disorders, says: “We know how important it is for people to get evidence-based psychological treatment for their eating disorder, and that pharmacological treatment is not sufficient by itself. This study seems to be saying that because it isn’t easy to access CBT and other evidence-based psychological treatments, these drugs are an alternative.”