Pharmacological treatment of the core symptoms of Anorexia nervosa – a systematic literature review

Abstract: Background/Aim: Anorexia nervosa (AN) is a serious psychiatric disorder with one of the highest mortality rates of all psychiatric diagnoses. Today there is no approved pharmacological treatment of Anorexia Nervosa. The aim of this study is to investigate if there is some effective and safe pharmacological treatment of the core symptoms of Anorexia nervosa (AN) by conducting a systematic review. There is no newly published systematic review with the same aim and methodological approach. Methods: A systematic review was conducted by searching in the following databases: PubMed, Embase and PsycINFO using the PICO strategy. Randomized controlled studies from the latest 10 years were included. Primary outcome measurements were weight, BMI (Body mass index) and caloric intake and secondary was ED (eating-disorder psychopathology). The safety of the interventions was carefully evaluated. Two independent reviewers screened and performed the quality assessment using the GRADE approach. 12 studies were included. Results: Only four studies presented significant results of weight gain/BMI increase: dronabinol (1), olanzapine (2), D-Cycloserine in enhancement of exposure therapy (1). Oxytocin (1) had a positive impact on ED (eating disorder) psychopathology. The efficacy was generally modest. Overall, the studies had small sample sizes and a high level of heterogeneity. The weighted quality was very low mostly due to high drop-out rates which is a common problem in this population. All the drug therapies were safe and well tolerated and no adverse events were reported. Conclusion: The significant positive results need to be confirmed in larger high-quality long- term studies. Both the results regarding the weighted low quality of the included studies and the modest results regarding efficacy and the safety of the medications was overall in accordance with other systematic reviews regarding pharmacological treatment of AN.