进食障碍的精神药理学：随机对照试验的系统评价和荟萃分析。

Psychopharmacology of eating disorders: Systematic review and meta-analysis of randomized controlled trials.

机构信息

Section of Psychiatry - Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.

出版信息

J Affect Disord. 2023 Oct 1;338:526-545. doi: 10.1016/j.jad.2023.06.068. Epub 2023 Jun 30.

DOI:10.1016/j.jad.2023.06.068

PMID:37393954

Abstract

BACKGROUND

The concurrent assessment of weight and affective psychopathology outcomes relevant to the psychopharmacology of major eating disorders (EDs), namely anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), warrants systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

PubMed, Scopus, and ClinicalTrials.gov were inquired from inception through August 31st, 2022, for RCTs documenting any psychopharmacological intervention for EDs diagnosed according to validated criteria and reporting weight and psychopathology changes. Adopted keywords were: "anorexia nervosa," "bulimia nervosa," "binge eating disorder," "antidepressant," "antipsychotic," and "mood stabilizer." No language restriction applied.

RESULTS

5122 records were identified, and 203 full-texts were reviewed. Sixty-two studies entered the qualitative synthesis (AN = 22, BN = 23, BED = 17), of which 22 entered the meta-analysis (AN = 9, BN = 10, BED = 3). Concerning BMI increase in AN, olanzapine outperformed placebo (Hedges'g = 0.283, 95%C·I. = 0.051-0.515, I = 0 %; p = .017), whereas fluoxetine failed (Hedges'g = 0.351, 95%C.I. = -0.248 to 0.95, I = 63.37 %; p = .251). Fluoxetine not significantly changed weight (Hedges'g = 0.147, 95%C.I. = -0.157-0.451, I = 0 %; p = .343), reducing binging (Hedges'g = 0.203, 95%C.I. = 0.007-0.399, I = 0 %; p = .042), and purging episodes (Hedges'g = 0.328, 95%C.I. = -0.061-0.717, I = 58.97 %; p = .099) in BN. Lisdexamfetamine reduced weight (Hedges'g = 0.259, 95%C.I. = 0.071-0.446, I = 0 %; p = .007) and binging (Hedges'g = 0.571, 95%C.I. = 0.282-0.860, I = 53.84 %; p < .001) in BED.

LIMITATIONS

Small sample size, short duration, and lack of reliable operational definitions affect most of the included sponsored RCTs.

CONCLUSIONS

The efficacy of different drugs varies across different EDs, warranting additional primary studies recording broad psychopathological and cardiometabolic outcomes besides weight, especially against established psychotherapy interventions.

摘要

背景

针对主要进食障碍（ED）的精神药理学，即神经性厌食症（AN）、神经性贪食症（BN）和暴食障碍（BED），需要对相关体重和情感精神病理学结果进行系统评价和荟萃分析。

方法

从建库至 2022 年 8 月 31 日，通过 PubMed、Scopus 和 ClinicalTrials.gov 检索了记录根据验证标准诊断的任何精神药理学干预 ED 并报告体重和精神病理学变化的随机对照试验（RCT）。采用的关键词为：“神经性厌食症”、“神经性贪食症”、“暴食障碍”、“抗抑郁药”、“抗精神病药”和“心境稳定剂”。无语言限制。

结果

共确定了 5122 条记录，对 203 篇全文进行了审查。62 项研究进入定性综合分析（AN=22，BN=23，BED=17），其中 22 项研究进入荟萃分析（AN=9，BN=10，BED=3）。关于 AN 体重指数增加，奥氮平优于安慰剂（Hedges'g=0.283，95%CI.0.051-0.515，I=0%；p=0.017），而氟西汀则没有（Hedges'g=0.351，95%CI.-0.248 至 0.95，I=63.37%；p=0.251）。氟西汀对体重无显著影响（Hedges'g=0.147，95%CI.-0.157-0.451，I=0%；p=0.343），减少了 BN 中的暴食（Hedges'g=0.203，95%CI.0.007-0.399，I=0%；p=0.042）和清除发作（Hedges'g=0.328，95%CI.-0.061-0.717，I=58.97%；p=0.099）。利斯的明在 BN 中可降低体重（Hedges'g=0.259，95%CI.0.071-0.446，I=0%；p=0.007）和暴食（Hedges'g=0.571，95%CI.0.282-0.860，I=53.84%；p<0.001）。