Iatrogenic triggers for anorexia nervosa and bulimia nervosa: A WHO safety database disproportionality analysis

• Published in: Psychiatry research Vol. 327; p. 115415
• Main Authors: Merino, Diane, Gérard, Alexandre Olivier, Destere, Alexandre, Askenazy, Florence, Dor, Emmanuelle, Benoit, Michel, Cherikh, Faredj, Drici, Milou-Daniel
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.09.2023; Elsevier
• Subjects: Anorexia nervosa; Bulimia nervosa; Eating disorders; Life Sciences; Pharmaceutical sciences; Pharmacology; Pharmacovigilance; Side effect; Anorexia nervosa; Pharmacovigilance; Bulimia nervosa; Eating disorders; Side effect
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2023.115415

•Eating disorders result in the loss of over 3.3 million healthy life years worldwide.•Weight control attempts can be associated with drug misuse and abuse.•There is a safety signal regarding isotretinoin as a trigger of anorexia nervosa.•Other signals involve anticonvulsants, antiretrovirals, and psychotropic drugs.•In anorexia nervosa or bulimia nervosa, an iatrogenic trigger should be considered. Eating disorders, characterized by abnormal eating, weight control behaviors or both include anorexia nervosa (AN) and bulimia nervosa (BN). We investigated their potential iatrogenic triggers, using real-world data from the WHO safety database (VigiBase®). VigiBase® was queried for all AN and BN reports. The reports were classified as `pediatric' or `adult' according to age. Disproportionality analyses relied on the Information Component (IC), in which a 95% confidence interval lower-end positivity was required to suspect a signal. Our queries yielded 309 AN and 499 BN reports. Isotretinoin was disproportionately reported in pediatric AN (IC 3.6; [2.6–4.3]), adult AN (IC 3.1; [1.7–4.0]), and pediatric BN (IC 3.9; [3.0–4.7]). Lamivudine (IC 4.2; [3.2–4.9]), nevirapine (IC 3.7; [2.6–4.6]), and zidovudine (IC 3.4; [2.0–4.3]) had the highest ICs in adult AN. AN was associated with isotretinoin, anticonvulsants in minors, and antiretroviral drugs in adults. In adults, BN was related to psychotropic and hormonally active drugs. Before treatment initiation, an anamnesis should seek out mental health conditions, allowing the identification of patients at risk of developing or relapsing into AN or BN. In addition to misuse, the hypothesis of iatrogenic triggers for AN and BN should also be considered.