Pharmacotherapy BED — MRCPsych Paper B MCQ

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HardEating DisordersPharmacotherapy BEDMRCPsych Paper B

An adult with moderate-to-severe binge-eating disorder continues to have frequent binge-eating episodes despite completing recommended psychological treatment. At specialist review, adjunctive off-label pharmacotherapy is considered. Which medication has the strongest direct randomized-trial evidence among the options for reducing the number of binge-eating days?

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Correct answer: E — Lisdexamfetamine

Lisdexamfetamine has direct randomized-trial evidence in adults with moderate-to-severe binge-eating disorder: doses of 50–70 mg/day reduced binge-eating days and increased sustained binge cessation compared with placebo. However, it is not licensed for binge-eating disorder in the UK—the current UK SmPC lists ADHD indications only—so any such use is off-label and requires specialist assessment, including cardiovascular and misuse risks. NICE recommends binge-eating-disorder-focused guided self-help followed, where necessary, by CBT-ED, and medication must not be the sole treatment. Naltrexone monotherapy, metformin and lithium do not have comparably established evidence for reducing binge frequency. Olanzapine is not an established BED treatment and may cause clinically significant weight gain. Fluoxetine 60 mg was removed because that dose and indication relate specifically to bulimia nervosa rather than BED.

Reference: McElroy SL et al. Efficacy and safety of lisdexamfetamine for treatment of adults with moderate to severe binge-eating disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72(3):235–246. https://www.nice.org.uk/guidance/NG69/chapter/recommendations