Megestrol acetate for cachexia–anorexia syndrome. A systematic review
Abstract In 1993, megestrol acetate (MA) was approved by the US Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome. The mechanism by which MA increases appetite is unknown, and its effectiveness for ano...
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doaj-a09fc9a140c448f7ab75e039bc08375f2020-11-24T23:07:57ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092018-06-019344445210.1002/jcsm.12292Megestrol acetate for cachexia–anorexia syndrome. A systematic reviewVicente Ruiz‐García0Eduardo López‐Briz1Rafael Carbonell‐Sanchis2Sylvia Bort‐Martí3José Luis Gonzálvez‐Perales4Hospital at Home Unit, Tower C, Floor 1 Office 5 La Fe University Hospital Valencia Spain & CASPe SpainDepartment of Pharmacy La Fe University Hospital Valencia Spain, & CASPe SpainENT Department Sagunto Hospital Sagunto Spain, & CASPe SpainAcella Incubator Paterna SpainNational Health Service Algemesí SpainAbstract In 1993, megestrol acetate (MA) was approved by the US Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic, elderly, and acquired immunodeficiency syndrome patients is under investigation. This is an updated version of a Cochrane systematic review first published in 2005 and later updated in 2013 entitled ‘Megestrol acetate for the treatment of anorexia–cachexia syndrome’. MA vs. placebo: in studies where MA was compared with placebo, the overall results showed that MA patients gained weight (mean difference, MD 2.25 kg, 95% CI [1.19, 3.3]) but did not gain quality of life (QOL) (standarized mean difference, SMD 0.5, 95% CI [−0.13, 1.13]), with more adverse events (relative risk, RR 1.46, 95% CI [1.05, 2.04]), but no difference in deaths (RR 1.26, 95% CI [0.70, 2.27]). MA vs. no treatment: MA patients gained weight (MD 1.45 kg, 95% CI [0.15, 2.75]) but did not gain QOL (standardized mean difference 3.89 95% CI [−14, 6.28]). There was no increase in adverse events (RR 0.90, 95% CI [0.39, 2.08]) or deaths (RR 1.01, 95% CI [0.42, 2.45]). MA vs. active drugs: MA patients gained weight (MD 2.5 kg, 95% CI [0.37, 4.64]) but did not gain QOL (MD 0.20 95% CI [−0.02, 0.43]) and did not report an increase in adverse events (RR 1.05 95% CI [0.95, 1.16]) or in deaths (RR 1.53, 95% CI [1.02, 2.29]) Different doses of MA: in studies where lower doses of MA were compared with higher doses of MA, we did not find differences either in weight gain (MD −0.94 kg, 95% CI [−3.33, 1.45]), QOL (MD 0.31 95% CI [−0.19, 0.81]), or adverse events (RR 1.34, 95% CI [0.65, 2.76]). Thus, we cannot reach a conclusion for an optimal dose of MA.https://doi.org/10.1002/jcsm.12292AnorexiaAppetite StimulantsCachexiaSystematic ReviewMegestrol AcetateRandomized Controlled Trials |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Vicente Ruiz‐García Eduardo López‐Briz Rafael Carbonell‐Sanchis Sylvia Bort‐Martí José Luis Gonzálvez‐Perales |
spellingShingle |
Vicente Ruiz‐García Eduardo López‐Briz Rafael Carbonell‐Sanchis Sylvia Bort‐Martí José Luis Gonzálvez‐Perales Megestrol acetate for cachexia–anorexia syndrome. A systematic review Journal of Cachexia, Sarcopenia and Muscle Anorexia Appetite Stimulants Cachexia Systematic Review Megestrol Acetate Randomized Controlled Trials |
author_facet |
Vicente Ruiz‐García Eduardo López‐Briz Rafael Carbonell‐Sanchis Sylvia Bort‐Martí José Luis Gonzálvez‐Perales |
author_sort |
Vicente Ruiz‐García |
title |
Megestrol acetate for cachexia–anorexia syndrome. A systematic review |
title_short |
Megestrol acetate for cachexia–anorexia syndrome. A systematic review |
title_full |
Megestrol acetate for cachexia–anorexia syndrome. A systematic review |
title_fullStr |
Megestrol acetate for cachexia–anorexia syndrome. A systematic review |
title_full_unstemmed |
Megestrol acetate for cachexia–anorexia syndrome. A systematic review |
title_sort |
megestrol acetate for cachexia–anorexia syndrome. a systematic review |
publisher |
Wiley |
series |
Journal of Cachexia, Sarcopenia and Muscle |
issn |
2190-5991 2190-6009 |
publishDate |
2018-06-01 |
description |
Abstract In 1993, megestrol acetate (MA) was approved by the US Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with acquired immunodeficiency syndrome. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic, elderly, and acquired immunodeficiency syndrome patients is under investigation. This is an updated version of a Cochrane systematic review first published in 2005 and later updated in 2013 entitled ‘Megestrol acetate for the treatment of anorexia–cachexia syndrome’. MA vs. placebo: in studies where MA was compared with placebo, the overall results showed that MA patients gained weight (mean difference, MD 2.25 kg, 95% CI [1.19, 3.3]) but did not gain quality of life (QOL) (standarized mean difference, SMD 0.5, 95% CI [−0.13, 1.13]), with more adverse events (relative risk, RR 1.46, 95% CI [1.05, 2.04]), but no difference in deaths (RR 1.26, 95% CI [0.70, 2.27]). MA vs. no treatment: MA patients gained weight (MD 1.45 kg, 95% CI [0.15, 2.75]) but did not gain QOL (standardized mean difference 3.89 95% CI [−14, 6.28]). There was no increase in adverse events (RR 0.90, 95% CI [0.39, 2.08]) or deaths (RR 1.01, 95% CI [0.42, 2.45]). MA vs. active drugs: MA patients gained weight (MD 2.5 kg, 95% CI [0.37, 4.64]) but did not gain QOL (MD 0.20 95% CI [−0.02, 0.43]) and did not report an increase in adverse events (RR 1.05 95% CI [0.95, 1.16]) or in deaths (RR 1.53, 95% CI [1.02, 2.29]) Different doses of MA: in studies where lower doses of MA were compared with higher doses of MA, we did not find differences either in weight gain (MD −0.94 kg, 95% CI [−3.33, 1.45]), QOL (MD 0.31 95% CI [−0.19, 0.81]), or adverse events (RR 1.34, 95% CI [0.65, 2.76]). Thus, we cannot reach a conclusion for an optimal dose of MA. |
topic |
Anorexia Appetite Stimulants Cachexia Systematic Review Megestrol Acetate Randomized Controlled Trials |
url |
https://doi.org/10.1002/jcsm.12292 |
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