What is the number needed to treat (NNT) for a mid-forties female patient with Attention Deficit Hyperactivity Disorder (ADHD) and binge eating symptoms considering lisdexamfetamine (Vyvanse) treatment?

From the Guidelines

The Number Needed to Treat (NNT) for lisdexamfetamine (Vyvanse) in a mid-forties female with both ADHD and binge eating disorder is approximately 3-4 patients, as suggested by the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1. This means that for every 3-4 patients treated with Vyvanse, one will experience significant improvement in both conditions.

Key Considerations

• For treating ADHD symptoms alone, the NNT is around 2-3, while for binge eating disorder, the NNT is approximately 3-4.
• The recommended starting dose is 30mg once daily in the morning, potentially increasing to 50-70mg daily based on response and tolerability, as part of a comprehensive treatment plan that may include eating disorder-focused cognitive-behavioral therapy or interpersonal therapy 1.
• Treatment should continue for at least 4-6 weeks to properly assess efficacy.
• Common side effects include insomnia, decreased appetite, anxiety, and increased blood pressure and heart rate, which should be monitored regularly.
• Vyvanse works by increasing dopamine and norepinephrine levels in the brain, improving attention and executive function while reducing impulsivity that contributes to both ADHD symptoms and binge eating behaviors, making it a valuable option for patients with both conditions 1.

Treatment Approach

• The American Psychiatric Association recommends eating disorder-focused cognitive-behavioral therapy or interpersonal therapy as first-line treatments for binge-eating disorder, with lisdexamfetamine considered for patients who prefer medication or have not responded to psychotherapy alone 1.
• A comprehensive treatment plan should take into account the patient's individual needs, preferences, and medical history, with regular monitoring and adjustments as needed to minimize side effects and optimize efficacy.

From the Research

Efficacy of Lisdexamfetamine for Binge Eating Disorder

• The efficacy of lisdexamfetamine for the treatment of binge eating disorder (BED) has been demonstrated in several studies 2, 3, 4.
• A systematic review and meta-analysis found that lisdexamfetamine is an effective treatment for BED, reducing BED symptoms and body weight in patients with the disorder 3.
• A study examining the effects of lisdexamfetamine on eating behavior found that the drug reduced self-reported appetite ratings and intake of food, and enhanced sustained attention and reduced impulsive responding 5.

Number Needed to Treat (NNT)

• The pooled NNT for response (as defined by a Clinical Global Impressions-Improvement score of 'very much improved' or 'much improved') for lisdexamfetamine vs. placebo was 3 (95% CI 3-4) 4.
• The NNT for remission (as defined by 4-week cessation of binge eating) for lisdexamfetamine vs. placebo was 4 (95% CI 4-6) 4.

Safety Profile

• The safety profile of lisdexamfetamine is consistent with that of other long-acting stimulants, with common adverse events including dry mouth, decreased appetite, insomnia, and headache 2, 6, 4.
• The number needed to harm (NNH) for discontinuation due to an adverse event was 44 (95% CI 23-1971) 4.

Dosing and Administration

• The recommended dose range for lisdexamfetamine is 50-70 mg/day 4.
• Lisdexamfetamine has been shown to be effective at doses of 50 and 70 mg/day, with effect sizes ranging from 0.83 to 0.97 4.