CPG for Eating Disorders

9.13.2.2. What is the safety of topiramate in patients with BED?The answer is based on the NICE CPG 30 , where the results of RCTs are described basedon variables of interest, 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, etal. (2007) 245 . The updated search has no identified any new evidence. The studies are brieflydescribed in question 9.13.2.1.Scientific EvidenceThere is insufficient evidence to determine that there are clinically significantdifferences between topiramate (anticonvulsant) and placebo in the number of patientswho drop out of treatment for any reason (RR: 1.21; 95% CI: 0.67 to 2.16) or due toadverse effects (RR: 2.07; 95% CI: 0.57 to 7.52) based on 1 RCT (1 RCT; N=61;McEnroy, 2003) 304 .According to An RCT (McElroy, 2003) 304 , the following adverse effects were reported:headache, paresthesia and amenorrhoea in the topiramate group. In the placebo group:cramps, sedation and testicular pain. The overall dropout rate was 47% in the topiramategroup and 39% in the placebo group.RCT1++RCT1+Recommendations(See recommendations 9.GPH.1. to 9.GPH.6.)9.14. Atomoxetine9.14.1. What is the efficacy of atomoxetine in patients witheating disorders?No evidence has been found in the NICE CPG (2004) 30 or in the high-quality SRSE 31, 202, 211, 245 .The updated search has identified one RCT.Scientific EvidenceOne RCT (McElroy, 2007) 316 compared atomoxetine (40-120 mg/day doses; N=20) vs.control group (N=19) over 10 weeks in a group of patients with BED (age: 18 to 65years). The group treated with atomoxetine significantly reduced the weekly frequency ofbinge-eating (p=0.018), the daily frequency of binge-eating (p=0.003) and the diseasescale (p=0.015). No significant differences were found in other results. 30% of patientsin the treated group and 45% in the placebo group did not complete the study.RCT1+155CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS