Topiramate Useful for Binge Eating Disorder in Obesity

Laurie Barclay, MD

February 07, 2003

Feb. 7, 2003 -- Topiramate is useful for binge eating disorder in obesity, according to the results of a randomized, placebo-controlled trial reported in the February issue of the American Journal of Psychiatry. Mean weight loss was more than 5 kg during the 14-week trial.

"There is no established ideal treatment for binge eating disorder, particularly when it is associated with obesity," write Susan L. McElroy, MD, and colleagues from the University of Cincinnati College of Medicine in Ohio.

Evidence that topiramate, an antagonist at kainate/AMPA glutamate receptors, might be effective in the treatment of binge eating disorder includes improvement of comorbid binge eating disorder in patients treated with topiramate for mood disorders, and anorexia and weight loss noted in patients treated with topiramate for epilepsy. In animal studies, stimulation of the lateral hypothalamus by glutamate and glutamate agonists, including kainate/AMPA agonists, causes an intense, rapid, dose-dependent increase in food intake.

In this 14-week trial, 61 outpatients (53 women and eight men) with binge eating disorder and obesity (body mass index >= 30 kg/m 2) received topiramate at a flexible dose of 25 to 600 mg/day or placebo. Median topiramate dose was 212 mg/day (range, 50-600 mg/day).

Compared with the placebo group, the topiramate group had a significantly greater rate of reduction in binge frequency (94% vs. 46%), binge day frequency (93% vs. 46%), body mass index, weight, and scores on the Clinical Global Impression severity scale and the Yale-Brown Obsessive Compulsive Scale modified for binge eating. Mean weight loss for topiramate-treated subjects who completed the study was 5.9 kg.

Adverse events led to study discontinuation in six patients who received topiramate and three patients who received placebo. The most common reasons for discontinuing topiramate were headache in three patients and paresthesias in two patients.

Study limitations include limited duration of double-blind therapy of only 14 weeks, completion of the 14-week treatment phase by only 35 of the 61 patients, and adverse events more common in topiramate-treated patients, which may have compromised blindness to treatment assignment.

"The reduction in binge frequency and the overall improvement observed with topiramate in this study are at least comparable to the results reported in studies of selective serotonin reuptake inhibitors and d-fenfluramine in binge eating disorder, desipramine in nonpurging bulimia nervosa, and imipramine in binge eating associated with obesity," the authors write. "The weight loss effect appears greater for topiramate, but this should be addressed in comparison trials.... Topiramate may represent a promising new treatment for binge eating disorder associated with obesity."

Ortho-McNeil Pharmaceutical supported this study and employed some of its authors.

Am J Psychiatry. 2003;160:255-261

Reviewed by Gary D. Vogin, MD

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