Thursday, January 15, 2015

ADHD Drug Vyvance for Binge Eating Disorder?

Yesterday a study was published in JAMA Psychiatry. In it researchers looks at the impact of 14 weeks of 3 different doses of lisdexamfetamine (Vyvance) on binge eating disorder and weight in 260 patients via a randomized, double-blind, parallel-group, forced dose titration, placebo-controlled trial. Eligibility for the study included meeting the DSM-IV criteria for binge eating disorder, having a BMI between 25 and 45, and being between the ages of 18 and 55. There were a boatload of exclusion criteria with perhaps the most important being having any other eating or psychiatric disorder, having had a history of substance abuse, or having been recently treated with a psychostimulant, or having had a recent psychological or weight management treatment history.

The study's primary endpoint was the number of self-scored binge eating days, and among the secondary endpoints was weight.

The results were striking, especially in those taking the highest dose who nearly stopped binging.

Weight loss was also not insignificant, again, especially with the higher dose, with those folks losing an average of nearly 10lbs over the 11 weeks (versus an average loss of 1/5th of a pound for those taking a placebo).

Unfortunately there were also side effects with dramatically more people in the highest dosing arm reporting dry mouth, and insomnia. All told 5% of the highest dosing arm dropped out due to adverse effects.

While far from conclusive, this study is promising. Binge eating disorder is a tremendously difficult condition to endure. Psychologically it can be devastating due to overwhelming feelings of guilt which in turn can lead to decreased self-esteem and decreased perceived self-efficacy. Right now treatment for binge eating disorder involves cognitive behavioural therapy, and indeed, there's fair success, but were there a safe medication that could be used as an adjunct to counselling, speaking personally, I'd be thrilled.

There's still lots of work to be done to prove long term efficacy, safety, and tolerability. Fingers crossed.

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