CPG for Eating Disorders

9.16.3. Binge-eating disorder9.16.3.1. What is the efficacy of combined interventions in patients withBED?The answer is based on NICE CPG (2004) 30 , which describes the results yielded by RCTs,and on the high-quality SRSEs (1++), one elaborated by the AHRQ of the US (2006) 31 and themore recently published one conducted by Brownley, et al. (2007) 245 . The updated search hasidentified one new RCT.Scientific EvidenceAn RCT (Grilo, 2005; USA) 329 compared fluoxetine (60 mg/day) vs. placebo vs. CBT vs.CBT-fluoxetine in 108 adult patients (78% women) diagnosed with BED and treated onan outpatient basis for 16 weeks. The groups that received CBT (alone or in combinationwith fluoxetine) achieved better results than the placebo and the fluoxetine alone groupsto reduce the frequency of binge-eating episodes, ED-related symptoms, depression, andgreater frequency of remission. There were no differences with regard to weight.An RCT (Agras, 1994; USA) 325 compared CBT (3 months) – weight loss therapy (6months) –weight loss therapy (9 months) vs. CBT (3 months) – weight loss therapy (6months) - desipramine (300 mg/day) in 109 adult women with BED on an outpatientbasis. The groups that received CBT experienced a significant in the binge-eatingepisodes after 12 weeks of treatment, even though the effect was not maintained at the 1year follow up. There were no differences regarding depression scores among thegroups. At treatment initiation, the weight loss was greater in the group receiving weightloss therapy. At the 3-month follow up, the weight loss was greater in the CBTdesipraminegroup (mean weight loss: 4.8 Kg).An RCT (Grilo, 2005; USA) 330 compared CBT-orlistat (120 mg 3/day) vs. CBT-placeboover12 weeks of treatment in 50 adult patients (88% women) (BMI>30) with BEDundergoing outpatient treatment. The group on orlistat had a greater remission rate attreatment completion, but not so at the 2-month follow up. This group also experiencedweight loss.An RCT (Devlin, 2007; USA) 331 comprised of 116 people suffering from BED (90females and 26 males) (age range: 18-70 years) compared individual CBT- fluoxetinevs. individual CBT over 5 months with a follow up at +2 years. Both groups showed animprovement in the frequency of the binge-eating episodes and their remission after 2months of treatment. The odds ratio (odds at 24months/ post-treatment) for remission ofthe binge-eating episodes at 2 years after treatment was 1.373 times the odds atcompletion of 5 months of treatment. Subjects who received individual CBTexperienced a greater reduction in the frequency of binge-eating episodes and greaterremission odds ratio of such episodes as compared to the subjects who had not receivedthis therapy at 2 years. There were no differences regarding weight in neither of thegroups. The group that received fluoxetine achieved better results in the reduction ofdepressive symptoms at 2 years. A short-term treatment may show benefits in the longterm and not all treatments are equivalent in terms of the benefits they provide.RCT1++RCT1+RCT1++RCT1++168CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS