Efficacy and Safety of Lisdexamfetamine Versus Topiramate Versus Naltrexone/Bupropion in Individuals With Binge Eating Disorder: A Network Meta-Analysis.

OBJECTIVE

To compare the efficacy and safety of lisdexamfetamine, topiramate, and naltrexone/bupropion for treating binge eating disorder (BED) using network meta-analysis.

METHOD: We systematically searched PubMed, Scopus, ClinicalTrials.gov, and Cochrane Central up to February 2025 for randomized controlled trials evaluating these medications versus placebo in adults with BED. Primary outcomes were changes in binge eating frequency and body weight; secondary outcomes included serious adverse events, discontinuation rates, and common side effects. A frequentist random-effects network meta-analysis was performed.

RESULTS

Twelve trials (n = 1988) met inclusion criteria. Both lisdexamfetamine (MD -1.61, 95% CI: -2.41 to -0.81) and topiramate (MD -1.63, 95% CI: -2.53 to -0.74) significantly reduced binge eating frequency versus placebo, with comparable efficacy. Topiramate produced the greatest weight loss (MD -5.5 kg), followed by lisdexamfetamine (-4.6 kg). Naltrexone/bupropion did not significantly reduce binge frequency (MD -2.07, 95% CI: -4.45 to 0.31). Lisdexamfetamine was associated with higher risks of dry mouth and gastrointestinal events. No significant increase in serious adverse events was observed for any medication.

CONCLUSIONS

Topiramate and lisdexamfetamine are effective for reducing binge episodes and weight in BED. Naltrexone/bupropion showed modest weight effects but lacked clear efficacy for binge reduction. These findings support topiramate and lisdexamfetamine as primary pharmacologic options for BED.