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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