title: Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.
abstract: OBJECTIVE
  We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings.
  
  
  METHODS
  One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes.
  
  
  RESULTS
  Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss.
  
  
  CONCLUSIONS
  Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED.
  
  
  BACKGROUND
  clinicaltrials.gov: NCT00537810 (PsycINFO Database Record
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Marney A
authors.initials: MA
authors.lastname: White
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Masheb
authors.affiliation: Department of Biostatistics, Yale University School of Public Health.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D056912:Binge-Eating Disorder / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003503:Cyclobutanes / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D011320:Primary Health Care; D011379:Prognosis; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D019440:Anti-Obesity Agents; D003503:Cyclobutanes; C058254:sibutramine