Among patients who rated lisdexamfetamine’s efficacy lower for binge eating disorder, nearly half (44.4%) cited diminished therapeutic effects over time, while others reported side effects such as insomnia and energy crashes (P < 0.05), according to a recent study.
Researchers conducted a mixed-methods analysis using self-reported patient reviews from Drugs.com to evaluate perceptions of lisdexamfetamine (LDX) for binge eating disorder (BED); however, the study was limited by self-selection bias and unverified patient-reported diagnoses. The study, published in Psychiatry Research Communications, relied on patient narratives rather than clinical trial data. Researchers incorporated qualitative thematic analysis and quantitative data from 111 patient reviews on Drugs.com to assess subjective experiences and perceived efficacy on a 1 to 10 scale.
The researchers, led by Abanoub J. Armanious of the Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, identified seven primary themes from patient narratives: binge eating and appetite control, weight changes, sleep and energy levels, physiological side effects, psychiatric effects, intent to discontinue treatment, and the perceived need for adjunct psychotherapy. Of the 90 reviews analyzed before thematic saturation, 89 included efficacy ratings, with a median rating of 9.0 and a mean of 7.89 (standard deviation = 2.76). Notably, 59.6% of respondents provided the highest efficacy ratings (9–10). The most frequently reported rating was 10 (37 respondents), followed by 9 (16 respondents).
Patients who rated LDX efficacy highly (scores 9–10; n = 53) commonly reported reductions in binge eating (81.1%), improved focus (52.8%), and weight loss (50.9%) (P < 0.05). Conversely, those with lower efficacy ratings (scores 1–8; n = 36) frequently cited loss of efficacy over time (44.4%), insomnia (22.2%), binge eating recurrence in the evening (16.7%), and energy crashes in the afternoon (13.9%) (P < 0.05).
While long-term clinical trials have demonstrated sustained therapeutic benefits of LDX, the researchers acknowledged a disconnect between patient perceptions and clinical data. Some patients reported diminished efficacy over time, which warranted further investigation into potential tolerance effects. Others (8.3%) reported weight gain, despite LDX’s known appetite-suppressing effects.
Some patients reported that LDX’s effects waned by evening, which aligned with peak binge-eating risk. A subset of respondents attempted to mitigate this effect by delaying dosing, but doing so sometimes resulted in sleep disturbances. Tolerance was another concern: Multiple respondents noted reduced effectiveness over prolonged use. While insomnia (22.2%) and energy crashes (13.9%) were statistically significant contributors to lower ratings (P < 0.05), many patients still rated LDX highly, indicating that perceived efficacy often outweighed these side effects. Additionally, 15 respondents expressed a desire to discontinue treatment due to perceived dependency risks, while six cited financial barriers.
Patients generally perceived LDX as effective for BED, but self-reported concerns about tolerance, side effects, and cost suggest potential barriers to continued use, though the study did not directly measure adherence. Researchers identified concerns regarding dosing timing and sustained efficacy, warranting further study.
Full disclosures can be found in the published study.
