CPG for Eating Disorders

9.12.1.2. What is the safety of opioid antagonists in patients with BN?The answer is based on the NICE CPG (2004) 30 . The updated search has not yielded any newevidence.Scientific EvidenceThere is insufficient evidence to determine that opioid antagonists (naltrexone) are moreor less acceptable to patients when compared to placebo in women with mean age 25years who have been diagnosed with BN (2 RCTs; N=28; Huseman, 1990 312 ; Mitchell,1989 313 ).RCT1++Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)9.13. Topiramate9.13.1. Bulimia nervosa9.13.1.1. What is the efficacy of topiramate in patients with BN?Evidence is based on the high-quality SRSE (1++) elaborated by the AHRQ of the US(2006) 31 and also on a more recently published high-quality SRSE (1++) (Shapiro, et al., 2007) 211 .The updated search has not identified any new evidence.Scientific Evidence2 RCTs (Hoopes, 2003; USA 314 ; Hedges, 2003; USA 315 ) compared topiramate vs. placeboin 68 adult patients (97% women) with BN who were being treated on an outpatientbasis. The proportion of abstinence from binge-eating and purging was 22.6% in thetopiramate group and 6% in the placebo group, a non-significant difference. Thetopiramate group was associated with significant reduction of anxiety but not depression,and with a greater tendency towards weight loss. The control group had a tendencytowards weight gain.RCT1+Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)153CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS