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Treatments for bulimia nervosa: a network meta-analysis

Published online by Cambridge University Press:  06 May 2018

Eric Slade ,
Edna Keeney ,
Ifigeneia Mavranezouli ,
Sofia Dias ,
Linyun Fou ,
Sarah Stockton ,
Leanne Saxon ,
Glenn Waller ,
Hannah Turner  and
Lucy Serpell
...Show all authors
Eric Slade*
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Edna Keeney
Affiliation:
University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Ifigeneia Mavranezouli
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
Sofia Dias
Affiliation:
University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
Linyun Fou
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Sarah Stockton
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK
Leanne Saxon
Affiliation:
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, London, NW1 4RG, UK Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
Glenn Waller
Affiliation:
Department of Psychology, University of Sheffield, Floor D, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
Hannah Turner
Affiliation:
Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton, SO19 5ES, UK
Lucy Serpell
Affiliation:
University College London, 1-19 Torrington Place, London, WC1E 7HB, UK Eating Disorder Service, North East London Foundation NHS Trust, Porters Avenue Health Centre, 234 Porters Avenue, Dagenham, Essex RM8 2EQ, UK
Christopher G. Fairburn
Affiliation:
University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
Tim Kendall
Affiliation:
National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot St, Whitechapel, London E1 8BB, UK
*
Author for correspondence: Eric Slade, E-mail: eslade@rcog.org.uk
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Abstract

Background

Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults.

Methods

A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment.

Results

We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19–14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51–10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence.

Conclusions

The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

Keywords

Bulimia nervosaeating disorderNational Institute of Health and Care Excellencenetwork meta-analysisoutcome research
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 16 , December 2018 , pp. 2629 - 2636
Copyright
Copyright © Cambridge University Press 2018 

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