Specific treatments linked to modest improvement in anorexia nervosa, but more data needed
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Specific psychological treatments for adult outpatients with anorexia nervosa were linked to modest clinical course and quality of life improvements vs. treatment as usual, according to study results published in The Lancet Psychiatry.
However, no reliable evidence supported clear superiority or inferiority of the treatments recommended by clinical guidelines internationally, researchers noted.
“In 2018, a network meta-analysis attempted to identify the best treatment for adults with anorexia nervosa, showing that nothing works better than [specialist supportive clinical management] and exclusively reporting on weight outcome,” Marco Solmi, MD, PhD, of the neurosciences department at the University of Padua in Italy, and colleagues wrote. “However, this analysis had some important methodological flaws that undermine the validity of its findings and, since its publication, new studies have been published. The aim of the present work is to compare standalone psychological interventions for adult outpatients with anorexia nervosa with a specific focus on weight, eating disorder symptoms and all-cause dropout rate.”
In the current study, the investigators included 16 randomized controlled trials for psychological treatments in the systematic review, and 13 of these were included in the network meta-analysis, which featured 1,047 total patients (97.4% women). The included trials evaluated standalone pharmacological or non-pharmacological treatments among adult outpatients with anorexia nervosa, defined based on standardized criteria, with data for two or more timepoints relating to either BMI or global eating disorder psychopathology. The researchers obtained studies from four databases from inception until March 20, 2020. Change in BMI and clinical symptoms served as the primary outcomes; all-cause dropout rate served as the secondary outcome. The researchers assessed all outcomes for treatment as usual, cognitive behavioral therapy, Maudsley anorexia treatment for adults, family-based treatment, psychodynamic-oriented psychotherapies, a form of CBT targeting compulsive exercise and cognitive remediation therapy followed by CBT.
Regarding primary outcomes, the researchers noted that none of the interventions outperformed treatment as usual; however, the all-cause dropout rate was lower for CBT vs. psychodynamic-oriented psychotherapies. They observed heterogeneity or inconsistency only for a few comparisons and noted that the confidence in the evidence was low to very low.
“The principal investigators of past and future studies should make data freely available to allow individual patient data (network) meta-analyses, which might reveal whether subgroups of patients benefit the most from specific interventions,” Solmi and colleagues wrote. “If differences are identified, such a finding could be crucial for evaluating the suitability and prospect of the outpatient pathway, with important implications for routine clinical practice. As researchers and clinicians, we also need to learn much more about non-specific therapist effects, their contribution to outcome and how they might affect different types of therapy.”