Investigational drugs for the treatment of binge eating disorder (BED): an update

ABSTRACT

Introduction: Binge eating disorder (BED) is the most common eating disorder and is frequently associated with psychiatric and medical comorbidities and functional impairment. Although psychological treatments have been the cornerstones of BED treatment, pharmacologic interventions also play an important part of the multimodal management of this condition.

Areas covered: This review examines investigational, approved and other pharmacological agents for the treatment of BED. We searched PubMed and clinicaltrials.gov to identify pharmacological interventions for the management of this condition.

Expert opinion: BED pharmacological studies have incorporated new drug targets based on our enhanced understanding of the pathophysiology of BED. Neurobiological dysregulation in the reward center and impulse control circuitry and related disturbances in dopamine neurotransmission are among the neurobiological explanations that have been suggested for BED. These mechanisms serve as a pharmacodynamic foundation for the development of new compounds such as lisdexamfetamine (LDX) and dasotraline. Despite these advances, pharmacological trials in BED have numerous challenges that must be overcome. For most compounds studied, larger and more definitive trials is a high priority.

KEYWORDS:

• Eating disorders
• binge eating disorder
• medication
• pharmacotherapy

Article Highlights

• BED is a serious mental health condition that is often associated with other psychiatric and medical comorbidities; it is often underdiagnosed and undertreated.

• Psychological treatments including cognitive behavior therapy (CBT) are the first-line treatment for BED; however, not all patients respond to these interventions.

• A group of potential drug targets involving neurotransmitters/hormones like dopamine, glutamate (NMDA receptors) and endogenous opioids (MOR, NOP receptors) have been explored in animal models and some small clinical trials.

• New insights into the underlying mechanisms involved in BED pathophysiology have influenced the clinical development of pharmacological agents.

• In two randomized placebo-controlled trials, dasotraline is demonstrated to be efficacious and well tolerated in the treatment of BED.

• The design and implementation of larger and more definitive clinical trials is a high priority for determining efficacy and safety of those agents under investigation.

This box summarizes key points contained in the article.

Declaration of interest

JC Appolinario receives/has received research grants, consultancy fees, and advisory board fees from Shire Pharmaceuticals. He receives/has received royalties/honoraria from Artmed Panamericana Editora. He also received a research grant from the Brazilian National Research Council (CNPq). AE Nardi receives/has received research grants from FAPERJ (Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro) and from the Brazilian National Research Council (CNPq). SL McElroy is a consultant to and has received grant support from Shire. In addition, she is also a consultant to or member of the scientific advisory boards of Alkermes, Bracket, Corcept, F. Hoffmann-LaRoche Ltd, MedAvante, Myriad, Naurex, Novo Nordisk, Sunovion, and Teva. She has also received grant support from the Agency for Healthcare Research & Quality (AHRQ), Alkermes, AstraZeneca, Cephalon (now Teva), Forest, Lilly, Marriott Foundation, the National Institute of Mental Health, Orexigen, Pfizer, Takeda, and Transcept. She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders and, along with the patent’s assignee (University of Cincinnati; Cincinnati, Ohio), has received payments from Johnson & Johnson, which has exclusive rights under the patent. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee previously sat on the Canadian BED Advisory Board for Shire Pharmaceuticals. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.