World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders

Himmerich, Hubertus; Lewis, Yael Doreen; Conti, Chiara; Mutwalli, Hiba; Karwautz, Andreas; Sjögren, Jan Magnus; Isaza, María Mercedes Uribe; Tyszkiewicz‐Nwafor, Marta; Anders, Martin; McElroy, Susan L.; Treasure, Janet; Kasper, S.; Bailer, Ursula F.; Bulik, Cynthia M.; Zwaan, Martina de; Favaro, Angela; Fernández‐Aranda, Fernando; Fetissov, S.; Hilbert, Anja; Hoek, Hans W.; Kan, Carol; Karpenko, Olga; Kaye, Walter H.; Mitchell, James E.; Monteleone, Palmiero; Mörkl, Sabrina; Müller, Daniel J.; Nazar, Bruno Palazzo; Papežová, Hana; Steiger, Howard; Stein, Daniel R.; Szabo, Christopher Paul; Voderholzer, Ulrich; Wade, Tracey; Wranik, Wiesława D.; Yoshiuchi, Kazuhiro

doi:10.1080/15622975.2023.2179663

Cited by 45 publications

(41 citation statements)

References 262 publications

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“…In individuals with BED, CBT and pharmacotherapy are sup ported by the current findings, which is in line with guidelines 35 that suggest the use of CBT, selective serotonin reuptake inhibitors, anticonvulsants (topiramate) and anti obesity (orlistat) drugs. Lis dexamfetamine has been approved only in some countries, and long term effectiveness of medications has not been proven 89,90 . The efficacy of stimulants or topiramate in BED might be partially mediated by appetite suppression.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Solmi,

Monaco,

Højlund

et al. 2024

World Psychiatry

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Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta‐analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD‐defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all‐cause and ED‐related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow‐up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44‐49, n=283, mean follow‐up: 44.9±62.8 months, no significant ED‐group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23‐29, n=170, mean follow‐up: 59.3±71.2 months, no significant ED‐group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2‐0.7, n=214, mean follow‐up: 72.2±117.7 months, no significant ED‐group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person‐years (95% CI: 4.4‐6.1, n=167, mean follow‐up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18‐36, n=18, mean follow‐up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self‐injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio‐demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family‐based therapy, cognitive‐behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self‐help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

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Section: Discussionmentioning

confidence: 99%

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Solmi,

Monaco,

Højlund

et al. 2024

World Psychiatry

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“…In light of the availability of case reports only, metreleptin was ranked as low evidence with a weak recommendation for use in AN in the World Federation of Societies of Biological Psychiatry guidelines update 2023 on the pharmacological treatment of eating disorders (Himmerich et al., 2023).…”

Section: Methodsmentioning

confidence: 99%

“…The slow increment of FLI during weight gain may explain why pharmacological studies entailing weight gain have not led to psychological improvements (Andries et al., 2014; Attia et al., 2019). The largest RCT for olanzapine (A‐level for the effectiveness of the intervention on weight gain (Himmerich et al., 2023)) included 75 adult outpatients (mean BMI: 16.8 ± 1.2 kg/m 2 ) with AN in the verum arm, who gained a mean of approximately 1 kg/m 2 at the end of the 16 weeks long study period (Attia et al., 2019). Based on current longitudinal evidence (e.g (Hebebrand et al., 1997)), this BMI increase cannot be expected to normalise leptin secretion.…”

Section: Methodsmentioning

confidence: 99%

Does hypoleptinemia trigger entrapment in anorexia nervosa? Etiological and clinical considerations

Hebebrand,

Plieger,

Milos

et al. 2024

Euro Eating Disorders Rev

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Based on the recent observation that human recombinant leptin (r‐Met‐hu‐leptin; metreleptin) may induce a profound alleviation of the complex symptomatology of patients with anorexia nervosa (AN), we examine the implications for our conceptualisation of this eating disorder. Hypoleptinemia as a core endocrine feature of AN serves as a central and peripheral trigger of tissue‐specific adaptations to starvation. In this narrative review, we argue that leptin deficiency may explain many of the puzzling features of this eating disorder. Weight loss can be viewed as a two‐step process, with only the second step entailing hypoleptinemia and thereby the entrapment characteristic of AN. We discuss the central and peripheral distribution of leptin receptors and consider possible functional implications of hypoleptinemia. We contrast the slow psychological recovery of patients with AN and of people who experienced starvation upon weight recovery with the rapid onset of improvements upon off‐label metreleptin treatment. Characteristics of the sex and age dependent secretion of leptin may contribute to the elevated vulnerability of young females to develop AN.

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“…Antipsychotic medications, specifically olanzapine (D2, 5-HT2 receptor antagonist) and aripiprazole, are effective in a small number of trials, case series and case reports in adults and adolescents with anorexia nervosa (Himmerich et al, 2023). However, the reluctance of patients to take olanzapine (Attia et al, 2011) and low adherence and acceptability rates (Attia et al, 2019) negate much of the potential efficacy of these medications and may account for why large clinical trials have not been possible to conduct in adolescent samples (e.g.…”

Section: Eating Disordersmentioning

confidence: 99%

Common pitfalls, and how to avoid them, in child and adolescent psychopharmacology: Part II

Cortese,

Besag,

Clark

et al. 2024

J Psychopharmacol

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As Faculty of the British Association for Psychopharmacology course on child and adolescent psychopharmacology, we present here what we deem are the most common pitfalls, and how to avoid them, in child and adolescent psychopharmacology. In this paper, we specifically addressed common pitfalls in the pharmacological treatment of autism and intellectual disability, eating disorders, neuropsychiatric correlates of epilepsy, and psychosis. Pitfalls in relation to the treatment of other disorders are addressed in a separate paper (Part I).

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World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders

Cited by 45 publications

References 262 publications

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

Does hypoleptinemia trigger entrapment in anorexia nervosa? Etiological and clinical considerations

Common pitfalls, and how to avoid them, in child and adolescent psychopharmacology: Part II

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