CPG for Eating Disorders

9.13.1.2. What is the safety of topiramate in patients with BN?Evidence is based on two RCTs included in the high-quality SRSE (1++) elaborated bythe AHRQ of the US (2006) 31 and also on a more recently published high-quality SRSE (1++)conducted by Shapiro, et al. (2007) 211 . The updated search has not identified any new evidence.The studies are briefly described in question 9.13.1.1.Scientific EvidenceIn the two previous RCTs (Hoopes, 2003 314 ; Hedges, 2003 315 ) one case of adverse effectwas reported in the form of facial rash and irritability in the topiramate group. Theoverall dropout rate was higher (47%) in the placebo group than in the topiramate group(34%).RCT1+Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)9.13.2. Binge-Eating Disorder9.13.2.1. What is the efficacy of topiramate in patients with BED?The answer is based on the NICE CPG (2004) 30 , on the high-quality SRSE (1++)elaborated by the AHRQ of the US (2006) 31 and on a more recently published high-quality SRSE(1++) conducted by Brownley, et al. (2007) 245 . The updated search has no identified any newevidence.Scientific EvidenceIn an RCT (McElroy, 2003; USA) 304 topiramate (average dose 212 mg/day) wascompared to placebo in 61 patients with eating disorders over 14 weeks on an outpatientbasis. Patients who received topiramate presented remission of binge-eating andsignificant reduction of its frequency. There were significant differences in weight lossbetween the group treated with topiramate (5.9 kg) and the placebo group (1.2 kg).There were no differences between groups in terms of depression scores 31 .There is limited evidence to suggest that there may be a clinically significant differencebetween topiramate and placebo in the remission of binge-eating by the end of treatment(1 RCT; N=61; McElroy, 2003 304 ; RR: 0.56; 95% CI: 0.34 to 0.92; NNT: 4; 95% CI: 2 to15).RCT1+RCT1++Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)154CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS