McElroy Susan L, Hudson James I, Gasior Maria, Herman Barry K, Radewonuk Jana, Wilfley Denise, Busner Joan
Lindner Center of HOPE, Mason, Ohio.
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Int J Eat Disord. 2017 Aug;50(8):884-892. doi: 10.1002/eat.22722. Epub 2017 May 8.
This study examined the time course of efficacy-related endpoints for lisdexamfetamine dimesylate (LDX) versus placebo in adults with protocol-defined moderate to severe binge-eating disorder (BED).
In two 12-week, double-blind, placebo-controlled studies, adults meeting DSM-IV-TR BED criteria were randomized 1:1 to receive placebo or dose-optimized LDX (50 or 70 mg). Analyses across visits used mixed-effects models for repeated measures (binge eating days/week, binge eating episodes/week, Yale-Brown Obsessive Compulsive Scale modified for Binge Eating [Y-BOCS-BE] scores, percentage body weight change) and chi-square tests (Clinical Global Impressions-Improvement [CGI-I; from the perspective of BED symptoms] scale dichotomized as improved or not improved). These analyses were not part of the prespecified testing strategy, so reported p values are nominal (unadjusted and descriptive only).
Least squares mean treatment differences for change from baseline in both studies favored LDX over placebo (all nominal p values < .001) starting at Week 1 for binge eating days/week, binge-eating episodes/week, and percentage weight change and at the first posttreatment assessment (Week 4) for Y-BOCS-BE total and domain scores. On the CGI-I, more participants on LDX than placebo were categorized as improved starting at Week 1 in both studies (both nominal p values < .001). Across these efficacy-related endpoints, the superiority of LDX over placebo was maintained at each posttreatment assessment in both studies (all nominal p values < .001).
In adults with BED, LDX treatment appeared to be associated with improvement on efficacy measures as early as 1 week, which was maintained throughout the 12-week studies.
本研究考察了在符合方案定义的中度至重度暴饮暴食症(BED)成人患者中,与安慰剂相比,二甲磺酸赖右苯丙胺(LDX)疗效相关终点的时间进程。
在两项为期12周的双盲、安慰剂对照研究中,符合《精神疾病诊断与统计手册第四版修订版》(DSM-IV-TR)中BED标准的成人患者按1:1随机分组,接受安慰剂或剂量优化的LDX(50或70毫克)。各访视期的分析采用重复测量的混合效应模型(每周暴饮暴食天数、每周暴饮暴食发作次数、为暴饮暴食症修改的耶鲁-布朗强迫量表[Y-BOCS-BE]评分、体重变化百分比)和卡方检验(临床总体印象-改善[CGI-I;从BED症状角度]量表,分为改善或未改善)。这些分析并非预先指定的测试策略的一部分,因此报告的p值为名义值(仅未调整且具有描述性)。
两项研究中,从基线开始变化的最小二乘均数治疗差异均显示,LDX在每周暴饮暴食天数、每周暴饮暴食发作次数和体重变化百分比方面,从第1周起优于安慰剂(所有名义p值<0.001),在Y-BOCS-BE总分和各领域评分方面,在首次治疗后评估(第4周)优于安慰剂。在CGI-I量表上,两项研究中从第1周起,被归类为改善的接受LDX治疗的参与者比接受安慰剂治疗的更多(两项名义p值<0.001)。在这些与疗效相关的终点中,两项研究在每次治疗后评估时,LDX均优于安慰剂(所有名义p值<0.001)。
在患有BED的成人患者中,LDX治疗似乎早在1周时就与疗效指标的改善相关,且在整个12周的研究中一直保持。