Naltrexone/bupropion maintenance therapy for binge-eating disorder superior to placebo

Key takeaways:

• Sixty-six adults with binge-eating disorder were given either naltrexone/bupropion or placebo for 16 weeks.
• Remission rates higher in those given combination therapy compared with placebo.

MIAMI BEACH, Fla. — Adults with binge-eating disorder who were given acute naltrexone/bupropion performed better with similar maintenance treatment compared with placebo, per data from the American Society of Clinical Psychopharmacology annual meeting.

“Despite being a prevalent problem associated with substantial morbidity, binge-eating disorder continues to go underrecognized by healthcare providers and most people go untreated or receive treatments without empirical support,” Carlos M. Grilo, PhD, lead study author and professor of psychiatry and psychology at Yale School of Medicine, told Healio in an email. “Unlike certain psychological treatments, the discontinuation of medications after treatment is often followed by relapse.”

Grilo and colleagues sought to determine efficacy of a combination maintenance treatment in those with comorbid obesity who responded well to acute treatments for binge-eating disorder in a prospective, randomized, double-blind, placebo-controlled, single-site clinical trial.

Researchers conducted the study between August 2017 and December 2021, including 66 adults (mean age 46.9 years; 84.8% female) randomized 1:1 to receive either naltrexone/bupropion (n = 32) or placebo (n = 34) for 16 weeks. Mixed models and generalized estimating equations comparing maintenance treatments (naltrexone/bupropion vs. placebo) included principal and interactive effects of acute treatments.

A total of 86.3% of participants completed posttreatment assessments.

Remission rates after maintenance treatments were 68.8% (22 of 32) in the combination naltrexone/bupropion group and 50% (17 of 34) in the placebo group.

Data showed placebo following response to acute treatment with naltrexone/bupropion was associated with significantly decreased probability of binge-eating remission, increased frequency and lack of weight loss. Conversely, the researchers wrote that naltrexone/bupropion therapy following response to acute treatment with the same combination was associated with good maintenance, low binge-eating frequency and significant weight loss.

“This controlled study found that patients with BED who responded well to initial treatment with naltrexone/bupropion should be offered maintenance treatment with the medication,” Grilo told Healio. “In contrast, patients who received and benefited from a behavioral therapy for BED did not seem to need maintenance pharmacotherapy treatment.”