Nouvelle publication SUAL: méta-analyse du topiramate dans le Binge Eating

Le topiramate est un anti-épileptique utilisé dans de nombreuses pathologies neuropsychiatriques en raison de ses vertus anti-impulsives. Dans les addictions, le topiramate est utilisé dans le trouble d'usage d'alcool et le trouble d'usage de cocaïne. Plusieurs méta-analyse ont retrouvé des effets positifs contre placebo sur la réduction des niveaux d'usage. Le topiramate a également des effets coupe-faim et fait perdre du poids. Plusieurs essais cliniques ont donc évalué son efficacité dans le trouble hyperphagique compulsif, ou Binge Eating Disorder en anglais. Aucune méta-analyse n'avait jusqu'ici été publiée. C'est chose faite désormais grâce à ce travail collaboratif entre le SUAL et le Service Hospitalo-Universitaire de Pharmacologie des Hospices Civils de Lyon. Une publication dans la revue de pharmacologie CNS Spectrum

Abstract en anglais

Objective: To assess the efficacy and safety of topiramate in treating binge eating disorder (BED), using a systematic review and meta-analysis of the available randomized clinical trials (RCTs).

Methods: The RCTs assessing topiramate versus placebo with or without adjunctive psychotherapy in BED were reviewed using a systematic search in the PubMed, Web of Science, PsycINFO, Cochrane Database of Systematic Review, and ClinicalTrials.gov search Websites, from inception to November 2019. Main outcomes were the changes in binge frequency, quality of life, and weight, respectively. Effect estimates were pooled using random-effect models and presented as risk ratios (RRs) or mean differences (MDs) and their 95% confidence interval (95%CI). Data extraction was performed by two independent reviewers.

Results: Three studies were eligible for inclusion, involving 528 BED patients. Topiramate was found to be significantly more efficacious than placebo in reducing: 1) the number of binge episodes per week (MD= -1.31; 95%CI= -2.58 to -0.03; I² = 94%); 2) the number of binge days per week (MD= -0.98; 95%CI= -1.80 to -0.16; I²=94%); and 3) weight (MD= -4.91 kg; 95%CI= -6.42 to -3.41; I²= 10%). However, participants in the topiramate groups withdrew significantly more frequently for safety reasons, relative to placebo participants (RR= 1.90; 95%CI= 1.13 to 3.18, I²=0%).

Conclusion: Preliminary findings supports a possible efficacy of topiramate for the treatment of BED, even if safety concerns could limit the practical use of this treatment in BED subjects.