cryinginmoscow

[HELP QUERY] Concerta XL vs Vyvanse for B.E.D (Binge Eating Disorder)

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Can someone tell me why Vyvanse is approved for Binge Eating Disorder, meanwhile other amphetamines aren't? Is it because Vyvanse targets different pathways that Concerta doesn't because I recently switched and I'm afraid I made a mistake.

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It's probably just that they put the money into clinical trial research to prove its efficacy in BED  whereas manufacturers didn't do so for other meds like dexamphetamine or methylphenidate. Usually they would just go for ADHD and narcolepsy approval for those meds. You can rest assured Concerta has an appetite reducing effect, although I don't know whether Vyvanse reduces it more or less than Concerta.

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Moving topic to CNS stimulants forum.

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Does anyone else have a more scientific explanation or are we just gonna say it's the money thing? 

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Off the cuff, I'd guess three things: longer acting, potentially lower abuse risk, and also money... if pharmaceutical companies can find additional uses for their meds that otherwise would run into a patent expiration, they can extend the patent.

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Posted (edited)

6 hours ago, Wooster said:

Off the cuff, I'd guess three things: longer acting, potentially lower abuse risk, and also money... if pharmaceutical companies can find additional uses for their meds that otherwise would run into a patent expiration, they can extend the patent.

Bingo!

  • Longer acting - Vyvanse has a slight edge over Concerta in most people
  • Lower abuse risk - Both are abuse-deterrent formulations, but Vyvanse is an actual prodrug and Shire even had the gall to ask for a Schedule III classification as a result (obviously failed, as it's nowhere near as good as the Shire marketing department likes to portray it).
  • Money/more uses - Shire explored Vyvanse for a plethora of uses, including in major depression (failed most of those trials). The ones that it succeeded in (ADHD and later BED) were the ones they pursued for marketing. Some major (mostly Shire-sponsored) trials of LDX in the past that haven't led to indications:
    • Adjunctive use with antipsychotics in schizophrenia (dropped initially, poor results in a later trial, another trial assessed safety)
    • Narcolepsy (seemingly successful initial trial)
    • Numerous studies on adjunctive use with antidepressants in MDD (spectacularly failed the first trial, results in subsequent trials mixed/discouraging)
    • MDD subpopulation with EFIs
    • TBI-related attention deficits (two trials, one on adults (completed), the other on children (recruiting))
    • "Cognitive Functioning Issues in Women Post-Oophorectomy" (two trials withdrawn, one was to use LDX alone, the other was to use LDX+estradiol)
    • Methamphetamine dependence (yes seriously - trial currently ongoing)
    • Bipolar Depression (trial terminated due to failure to meet enrollment goals, safety trial completed, another trial abruptly terminated with no results posted (not an encouraging sign), MRI trial terminated due to slow enrollment)
    • Cocaine dependence (yes seriously - results appear to be pretty disappointing since they didn't even bother with a statistical analysis on them, although a difference on both outcome measures was technically demonstrated, just not a very impressive one - a second and third trial has been completed but with no results posted yet for either trial)
    • Cognitive functioning in menopausal women (no data posted)
    • Cognitive functioning in MS (no results yet)
    • Interesting trial on the PK of LDX in post-bariatric patients - not sure if this is a generalized safety trial or if it could be Shire's precursor into trying to sell the drug for post-bariatric surgery use -- quite an interesting market, and with BED they certainly have precedent I guess...
Edited by JustNuts
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On 5/4/2017 at 2:14 AM, cryinginmoscow said:

Can someone tell me why Vyvanse is approved for Binge Eating Disorder, meanwhile other amphetamines aren't? Is it because Vyvanse targets different pathways that Concerta doesn't because I recently switched and I'm afraid I made a mistake.

I know for sure that Vyvanse is FDA approved for BED. I have seen pamphlets from Shire in mu previous pdoc's office. When I was on Vyvanse, Im telling you there was not 1 minute throughout the entire that I would think about food, much less have an appetite for food. The Vyvanse was around-the-clock coverage and so my appetite was suppressed for up to 14 hours at once. Perhaps Shire wanted to extend their Vyvanse patent even further so really needed to secure another indication so that patent could be extended another year. Alot of this is a mixture between business and science.

When I was on ritalin, I still had a (small) appetite and could eat, making me think Vyvanse would be your best option, given that it is also FDA approved for BED as well. And as JustNuts mentioned, the longer duration of action and lower abuse potential in vyvanse are particularly attracting when discussing treatment options with your physician

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10 hours ago, mmaryland said:

I know for sure that Vyvanse is FDA approved for BED. I have seen pamphlets from Shire in mu previous pdoc's office. When I was on Vyvanse, Im telling you there was not 1 minute throughout the entire that I would think about food, much less have an appetite for food. The Vyvanse was around-the-clock coverage and so my appetite was suppressed for up to 14 hours at once. Perhaps Shire wanted to extend their Vyvanse patent even further so really needed to secure another indication so that patent could be extended another year. Alot of this is a mixture between business and science.

When I was on ritalin, I still had a (small) appetite and could eat, making me think Vyvanse would be your best option, given that it is also FDA approved for BED as well. And as JustNuts mentioned, the longer duration of action and lower abuse potential in vyvanse are particularly attracting when discussing treatment options with your physician

I'm on Ritalin extended release. The reason I switched was that I wake up late and have insomnia. I don't see myself abusing amphetamines because I have never enjoyed uppers. 

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Vyvanse definitely works for BED. I had to decrease my dose because the appetite suppression was actually starting to become a problem. I was only ever hungry for dinner and when I did eat dinner it was incredibly unhealthy. So while I ultimately ate less, my eating habits were far worse. So it requires discipline to take Vyvanse and simultaneously force yourself to eat small meals in a healthy manner.

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