d-fenfluramine therapy for binge eating disorder - Tips from Other Journals

Author: Barbara Apgar
Date: May 1, 1997

Binge eating is a disorder characterized by the consumption of large amounts of food in a short period of time, followed by feelings of guilt and distress. These feelings, however, are not followed by behaviors to limit weight gain, such as vomiting or laxative abuse, as in bulimia nervosa. Pharmacologic treatment of binge eating disorder has shown limited effectiveness. Stunkard and associates performed an eight-week, double-blind, placebo-controlled clinical trial of the appetite suppressant d-fenfluramine to assess its effectiveness in the treatment of binge eating disorder.

The study included 50 severely obese women who met criteria for binge eating disorder, which include the frequency criterion of binge eating at least two days a week for six months. Before randomization, the subjects were given placebo for four weeks. After this initial placebo trial, 28 patients still met the frequency criterion and were assigned to the d-fenfluramine or placebo group. Women in the treatment group received 15 mg of d-fenfluramine once a day for the first week, twice a day for the next six weeks and once a day for the eighth week. Patients were asked to keep a binge diary, recording dates, times, places and degree of distress afterward. Weight loss was not encouraged.

A significant decline in the frequency of binge eating was noted in the group receiving d-fenfluramine. Ten of the twelve patients in the treatment group had adequate blood levels of d-fenfluramine. Of these patients, eight became binge-free, compared with four in the placebo group. At the four-month follow-up, the number of binges per week in the d-fenfluramine group was similar to the number in the group treated with placebo. The most common adverse effects in the active drug group were headache and diarrhea. Only one moderately severe reaction occurred in the form of a pruritic rash, which resolved after d-fenfluramine was discontinued. There was no weight loss in either group.

The authors conclude that an appetite suppressant can reduce the severity of binge eating disorder. However, study subjects also demonstrated a strong response to placebo in the initial phase. During this time, the average number of binges fell by 70 percent. Although the results are preliminary and will have to be confirmed with a larger group, they do point to treatment options for obese patients with this disorder who fail other therapies.

BARBARA APGAR, M.D., M.S. Stunkard A, et al. d-Fenfluramine treatment of binge eating disorder. Am J Psychiatry 1996;153:1455-59.

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