Potential Role of Glucagon-like Peptide-1 (GLP-1) Receptor Agonist in the Treatment of Bulimia Nervosa

Abstract

Background: Bulimia nervosa (BN) is a severe eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise. Current treatment strategies, including cognitive-behavioral therapy (CBT) and pharmacotherapy, have limitations, with many patients not responding adequately and experiencing high relapse rates. GLP-1 receptor agonists, initially developed for type 2 diabetes mellitus (T2DM) and chronic weight management, have shown potential in regulating appetite and modifying behavior, suggesting a possible role in treating BN. Objective: This review aims to assess the current evidence regarding the efficacy and safety of GLP-1 receptor agonists, particularly Semaglutide, in the treatment of bulimia nervosa. Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, focusing on articles published between 2014 and 2024. Studies included were clinical trials, case reports, and reviews addressing the use of GLP-1 receptor agonists in BN. The search terms included "Bulimia Nervosa," "Semaglutide," "GLP-1 receptor agonists," and related terms. After screening and removing duplicates, five relevant articles were included in the qualitative synthesis. Results: The included studies demonstrated that GLP-1 receptor agonists, such as Semaglutide, liraglutide, and dulaglutide, effectively reduced binge eating episodes and body weight in patients with BN. In a notable case report, a patient with long-standing BN experienced complete resolution of symptoms within two weeks of starting liraglutide, sustained over five years. Retrospective cohort and open-label studies also showed significant reductions in binge eating severity with GLP-1 receptor agonists compared to other anti-obesity medications. Additionally, preclinical studies suggested these agents' potential in modulating appetite and reward pathways in the brain. Conclusion: The evidence indicates that GLP-1 receptor agonists may be a promising alternative pharmacotherapy for bulimia nervosa, addressing both appetite regulation and behavioral aspects of the disorder. However, the current paucity of large-scale, randomized controlled trials necessitates further research to confirm these findings and establish the efficacy, safety, and optimal dosing of GLP-1 receptor agonists in the treatment of BN. The favorable psychiatric side effect profile and potential for improved patient adherence highlight the need for continued exploration of these agents in clinical practice.