Efficacy of pharmacotherapies for bulimia nervosa: a systematic review and meta-analysis

Objective The main purpose was to evaluate the efficacy and tolerability of different medications used to treat bulimia nervosa (BN). Methods Randomized controlled trials (RCTs) were identified from published sources through searches in PubMed, Cochrane Library, Web of Science, and Embase from inception to November 2022. Primary outcomes were changes in the frequency of binge eating episodes and vomiting episodes from baseline to endpoint. Secondary outcomes were differences in the improvement of scores in depressive symptoms, tolerability (dropout due to adverse events) and weight change. Results The literature search ultimately included 11 drugs, 33 studies and 6 types of drugs, 8 trials with TCAs (imipramine, desipramine), 14 with SSRIs (fluoxetine, citalopram and fluvoxamine), 6 with MAOIs (phenelzine, moclobemide and brofaromine), 3 with antiepileptic drugs (topiramate), 1 with mood stabilizers (lithium), and 1 with amphetamine-type appetite suppressant (fenfluramine). The reduction in binge eating episodes was more likely due to these drugs than the placebo, and the SMD was -0.4 (95% CI -0.61 similar to -0.19); the changes in the frequency of vomiting episodes (SMD = -0.16, 95% CI -0.3 similar to -0.03); weight (WMD = -3.05, 95% CI -5.97 similar to -0.13); and depressive symptoms (SMD = -0.32, 95% CI -0.51 similar to -0.13). However, no significant difference was found in dropout due to adverse events (RR = 1.66, 95% CI 1.14 similar to 2.41). Conclusions This meta-analysis indicates that most pharmacotherapies decreased the frequency of binge-eating and vomiting episodes, body weight, and depressive symptoms in BN patients, but the efficacy was not significant. In each drug the efficacy is different, treating different aspects, different symptoms to improve the clinical performance of bulimia nervosa.