Topiramate for the Treatment of Binge Eating Disorder Associated With Obesity: A Placebo-Controlled Study

Background In a single-center, placebo-controlled study, topiramate reduced binge eating and weight in patients with binge eating disorder (BED) and obesity. The current investigation evaluated the safety and efficacy of topiramate in a multicenter, placebo-controlled trial. Methods Eligible patients between 18 and 65 years with ≥ 3 binge eating days/week and a body mass index (BMI) between 30 and 50 kg/m2 were randomized. Results A total of 407 patients enrolled; 13 failed to meet inclusion criteria, resulting in 195 topiramate and 199 placebo patients. Topiramate reduced binge eating days/week (−3.5 ± 1.9 vs. −2.5 ± 2.1), binge episodes/week (−5.0 ± 4.3 vs. −3.4 ± 3.8), weight (−4.5 ± 5.1 kg vs. .2 ± 3.2 kg), and BMI (−1.6 ± 1.8 kg/m2 vs. .1 ± 1.2 kg/m2 ) compared with placebo ( p < .001). Topiramate induced binge eating remission in 58% of patients (placebo, 29%; p < .001). Discontinuation rates were 30% in each group; adverse events (AEs) were the most common reason for topiramate discontinuation (16%; placebo, 8%). Paresthesia, upper respiratory tract infection, somnolence, and nausea were the most common AEs with topiramate. Conclusions This multicenter study in patients with BED associated with obesity demonstrated that topiramate was well tolerated and efficacious in improving the features of BED and in reducing obesity.