Use of lisdexamfetamine in binge eating disorder: recommendations and current evidence

Background

The usefulness of lisdexamfetamine (LDX) for treating attention deficit hyperactivity disorder (ADHD) is well established [1]. Since its introduction to the market, the drug’s potential use in managing other disorders, including binge eating disorder (BED), has been considered [2]. In the United States, the FDA approved the drug for the treatment of BED in 2015, making it the first medication specifically for this condition. In Europe, however, it has not yet received official approval for this indication, although some studies have been conducted on the matter [3].

Objectives

Analyze the most relevant scientific literature to provide consistent recommendations on the use of lisdexamfetamine in binge eating disorder.

Methods

carrying out a narrative review of publications made in the Pubmed database with the following syntax: “Lysdexamfetamine” and “Binge eating disorder”. From this search, the following inclusion criteria were used: 1) The article was focused on the use of lisdexamfetamine as a pharmacological treatment, 2) The treatment was aimed at binge eating disorder, 3) The article was a meta-analysis, or a systematic review.

Based on these criteria, 14 articles were found.

Results

Lisdexamfetamine is the first and only drug to have received official approval for the treatment of BED in the United States. In that country, BED is also the most common eating disorder nationwide.

Several studies demonstrate that LDX has significant efficacy compared to placebo for the treatment of eating disorders (with a robust effect size) in: reducing the frequency of binge eating (number of binges per day), and reducing associated psychopathology (obsessions, compulsions, withdrawal, etc.). Furthermore, it causes changes in weight and body composition, with this effect being maintained in the medium term. All of this appears to modify the overall course of the illness, facilitating the reduction of disruptive behaviors and clinical remission.

The recommended dose for the treatment of BED is 50 mg/day or 70 mg/day.

Although LDX has a higher frequency of adverse effects than placebo, it is well tolerated in most studies, with no serious adverse effects observed. The most frequent adverse effects remain those present in other indications: headache, gastrointestinal issues, insomnia, and autonomic nervous system effects.

Evidence regarding the mechanism of action is more limited and appears to result from a combination of effects on appetite/satiety, reward, and cognitive processes, including impulsivity/inhibition. The main neurotransmitters involved are catecholamines and serotonin. Behavioral and neuroimaging studies are needed to provide more precise conclusions.

The drug’s maximum efficacy in BED is achieved when combined with psychotherapeutic intervention.

Conclusions

BED is a condition with considerable prevalence in the US and other regions. LDX shows moderate efficacy compared to placebo (and other drugs) in reducing behaviors associated with BED, as well as obsessive-compulsive symptoms (modified Yale-Brown eating Scale).

Furthermore, it has a good tolerability and safety profile, which supports its use as a first-line treatment for BED.

Despite this, its exact mechanism of action in eating disorders is unknown. In addition, systematic evaluations of the drug’s use in BED are scarce. Therefore, long-term studies are needed to confirm the observed results and provide new data.

References

-1. Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727-738. -2. Fornaro M, Mondin AM, Billeci M, et al. Psychopharmacology of eating disorders: Systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2023;338:526-545. -3. Himmerich H, Bentley J, McElroy SL. Pharmacological Treatment of Binge Eating Disorder and Frequent Comorbid Diseases. CNS Drugs. 2024;38(9):697-718.