Efficacy of topiramate in bulimia nervosa and binge-eating disorder:: a systematic review

Objective: The objective of this review was to establish the efficacy of topiramate as treatment for eating disorders associated with obesity. Methods: We reviewed all five published controlled clinical trials that tested the efficacy of topiramate in treating bulimia nervosa (BN) or binge-eating disorder (BED). Two trials involving 128 patients studied topiramate efficacy in BN, and three trials (528 patients) studied patients with BED. Data on the number of participants, weeks of follow-up, dropouts, binge frequency and weight were extracted. Results: Short-term treatment with topiramate is more effective than treatment with placebo in decreasing binge episodes per week (overall result: topiramate group: -5.0 +/- 0.6; placebo group: -3.3 +/- 1.2), binge days per week (topiramate group: -3.5 +/- 0.6; placebo group: -2.3 +/- 0.7) and corporal weight (topiramate group: -4.6 +/- 2.3; placebo group: -0.5 +/- 0.6) in both BN and BED. The high number of withdrawals and the small sample sizes in four of the five controlled clinical trials limit the generalizability of this result. Conclusion: Topiramate is effective in the short-term treatment of eating disorders associated with obesity. Additional studies are needed to prove its efficacy in the long term and to determine the optimal effective dose. (C) 2008 Elsevier Inc. All rights reserved.