Study Question: Is topiramate effective in the treatment of binge eating disorder associated with obesity?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Binge eating disorder is characterized by recurrent episodes of binge eating without the compensatory weight loss behaviors associated with bulimia nervosa or anorexia nervosa. Topiramate is approved for the treatment of epilepsy but also is associated with stabilization of mood disorders, anorexia, and weight loss.

Sixty-one patients (53 women and eight men) who met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) for binge eating disorder and obesity (body mass index of at least 30 kg per m²) were enrolled in a 14-week trial. Patients were randomized (concealed allocation assignment) to topiramate (initial dosage of 25 mg each evening titrated to a maximum dosage of 600 mg per day) or matching placebo.

Outcomes were assessed by patient self-report. Using intention-to-treat analysis, patients receiving topiramate reported a significantly greater reduction in binge frequency and binge day frequency, and improved scores on global impression severity and obsessive-compulsive scales. Patients taking topiramate also lost an average of 5.9 kg (13.0 lb); those taking placebo lost an average of 1.2 kg (2.7 lb). Only 58 percent of patients completed all 14 weeks of treatment. Nine patients (three taking placebo, six taking topiramate) discontinued treatment because of adverse events. The most common reasons for discontinuing topiramate were headache and paresthesia.

Bottom Line: Topiramate appears to be effective in the treatment of binge eating disorder associated with obesity. However, nearly one half of the study participants dropped out for various reasons, including adverse events, lack of treatment efficacy, or treatment non-adherence for unclear reasons. (Level of Evidence: 2b-)