Efficacy of naltrexone and bupropion combination in patients with binge eating disorder: a systematic review and meta-analysis

Binge Eating Disorder (BED) is a prevalent condition with limited evidence-based treatments. Naltrexone and Bupropion Combination (NB) targets neurobiological pathways implicated in BED. The Objective of this paper is to evaluate the efficacy of NB for BED in adults through a systematic review and meta-analysis. Following PRISMA guidelines, we searched major databases and trial registries (up to Feb 2025) for randomized controlled trials (RCTs) comparing NB to placebo or usual care in adults with BED. The primary outcome was binge eating frequency; secondary outcomes included weight loss and BMI. Risk of bias (ROB2) and certainty of evidence (GRADE) were assessed. A fixed-effects meta-analysis was performed. Four RCTs (n = 444 participants) met inclusion criteria. Meta-analysis of three studies indicated NB did not significantly reduce binge eating frequency compared to controls (Mean Difference [MD] − 1.49, 95% CI − 3.63 to 0.64, p = 0.17). However, NB significantly reduced weight (MD -3.57 kg, 95% CI − 4.86 to − 2.27, p < 0.001) and BMI (MD − 1.24 kg/m2, 95% CI − 1.79 to − 0.70, p < 0.001). The certainty of evidence was assessed as moderate for binge frequency and low for weight and BMI outcomes. NB aids weight reduction in adults with BED, but current evidence is insufficient to confirm its efficacy for reducing binge eating frequency. Further high-quality RCTs are warranted. Level I, systematic reviews and meta-analyses.