The network meta-analysis «Peat CM, Berkman ND, Lohr KN, ym. Comparative Effe...»1 presents results from the systematic review about the comparative effectiveness of selected treatments for adults with BED. Eligible studies were randomized controlled trials (RCTs) with sample sizes of 10 or more and published in English. Searches identified 4794 potentially relevant citations. The full systematic review included 87 of these publications and this study focused on the 42 studies providing evidence on the comparative effectiveness of treatment among adults with BED.
Participants were individuals of all races, ethnicities, and cultural groups who met DSM-IV or DSM-5 criteria for BED. Interventions included psychological, behavioral, pharmacological, or complementary and alternative treatments or combinations of treatments, and comparators included two or more active treatments.
Four major outcomes were of particular importance: binge-eating outcomes (e.g. abstinence, binge-eating frequency), eating-related psychopathology outcomes (e.g. obsessions, compulsions), weight-related outcomes (e.g. BMI), and general psychological outcomes (e.g. depressive symptoms).
A total of 12 trials provided evidence of comparative effectiveness of pharmacological interventions. A single head-to-head trial compared two second-generation antidepressants: fluoxetine and sertraline. The remaining 11 pharmacological trials contributed to the network meta-analysis of major outcomes. Of these, eight involved second-generation antidepressants (included bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, and sertraline) and three involved lisdexamfetamine. The evidence of comparative effectiveness of psychological treatments was reported in 18 trials (in 29 articles).
A total of 18 trials examined various forms of CBT (cognitive behavioural therapy), IPT (interpersonal therapy), BWL (behavioral weight loss treatment), dietary approaches, and inpatient interventions for managing BED. These 18 trials presented 26 treatment comparisons. Of these, four were replicated in more than one trial and 22 were confined to a single trial each.
Comparative effectiveness of therapist-led cognitive behavioral therapy versus therapist-led behavioral weight loss
Two trials reported significantly greater reductions in binge-eating frequency for participants receiving CBT than for those receiving BWL at end of treatment and up to 72 months follow-up. Strength of evidence was graded as low for CBT being more beneficial for reducing binge eating. Neither trial reported a significantly greater benefit of CBT on binge abstinence. In fact, in one trial, the percentage of patients abstinent at the end of treatment was significantly lower in the CBT group (41 %) than the BWL group (58 %); by 12-month follow-up, this difference essentially disappeared.
Because of these mixed abstinence results from these two trials, strength of evidence for abstinence as insufficient. Both trials reported statistically significant greater reductions in BMI for participants receiving BWL than for those receiving CBT at end of treatment (but not follow-up); strength of evidence was graded as moderate for BMI benefit from BWL.
The magnitude of change in BMI was substantial: at end of treatment, those receiving CBT decreased BMI by only an average of 0.41 points whereas those receiving BWL decreased BMI by an average of 2.2 points. However, by 12-month follow-up, this difference was no longer statistically significant, as those receiving BWL tended to gain weight.
As with the trials comparing different CBT variations, despite the fact that comparisons between BWL and CBT were mixed for abstinence and not significantly different for depressive symptoms, both treatments consistently produced better outcomes between baseline to the end of treatment across trials and these findings tended to persist at 12-month follow-up.
Summary
Network meta-analysis and qualitative results revealed important information on which interventions might be more effective in improving at least one type of outcome for patients with BED; these treatments include lisdexamfetamine, therapist-led CBT, and BWL. These interventions produced reductions in key BED outcomes including binge-eating abstinence and binge-eating frequency, but they did not demonstrate superiority on all relevant outcomes. Lisdexamfetamine was better at increasing binge abstinence than second-generation antidepressants; therapist-led cognitive behavioural therapy was better at reducing binge-eating frequency than behavioural weight loss, but behavioural weight loss was better at reducing weight.