A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss

Bodenner, Donald; Spencer, Horace J.; Riggs, Ann T.; Redman, Carolyn; Strunk, Billy; Hughes, T. Cann

doi:10.1016/j.amjopharm.2007.06.004

Cited by 25 publications

(10 citation statements)

References 44 publications

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“…44,45 Our findings thus go to show that even a small drop in weight can be significant in terms of prognosis and survival for NH residents, and thus monitoring their weight frequently could help underlying disease to be suspected sooner.…”

Section: Discussionmentioning

confidence: 88%

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

et al. 2015

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Section: Discussionmentioning

confidence: 88%

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

et al. 2015

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“…This concluded that mortality rates were increased in patients receiving MA, and risk appeared to be greater with higher doses (RR 1.43, 95% CI 1.05 to 1.96). A large retrospective case-controlled study of 709 nursing home patients with weight loss in America also reported increased mortality in patients receiving MA 46. The reason for this remains unclear; however, the Cochrane review also reported a slightly higher (but insignificant) increase in rates of thromboembolic phenomenon in patients receiving MA.…”

Section: Discussionmentioning

confidence: 99%

Progesterone therapy for the treatment of non-cancer cachexia: a systematic review

Taylor

Pendleton

2016

BMJ Support Palliat Care

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BackgroundCachexia describes a complex pathological syndrome of muscle wasting, anorexia and weight loss. Progesterone therapies have been shown to improve appetite and promote weight gain in patients with cachexia; however, research has focused heavily on patients with cancer, and its effectiveness in other diseases remains unclear.AimsThis systematic review aimed to present the evidence available for progesterone therapy as a treatment for non-cancer cachexia.MethodSurrogate outcome measures used were weight change, lean body mass (LBM), muscle strength, appetite, health-related quality of life (HRQOL) and serum albumin. Both randomised and non-randomised trials were included. A literature search of clinical trials using the medical subject heading (MeSH) terms ‘cachexia’ OR ‘anorexia’ OR ‘weight’ OR ‘frail (truncated)’ OR ‘appetite’ OR ‘wasting syndrome’ PLUS ‘megestrol acetate’ OR ‘medroxyprogesterone acetate’ was performed.ResultsEighteen studies were included in this review; 12 randomised control trials and 6 non-randomised trials. This collated results from 916 patients with HIV/AIDS, end-stage renal failure, chronic obstructive pulmonary disease (COPD) and geriatric cachexia. Meta-analysis comparing progesterone therapy with placebo concluded mean change in weight was not significant (mean difference (MD) 1.56, 95% CI −0.36 to 3.52, p=0.12). There was little evidence to show significant impact on LBM, and no trials looked at muscle strength. There was a paucity of evidence looking at appetite and HRQOL; however, results were generally positive.ConclusionsCurrent evidence does not support the use of progesterone therapies for non-cancer cachexia. There may however be a limited role for its use as an appetite stimulant in a palliative context on a case-by-case basis.

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“…Investigators conducted a case-control cohort study to determine whether exposure to megestrol acetate increased mortality rates in 709 case patients and 1418 matched control subjects living in a nursing home. 39 They observed no significant differences in baseline matching variables between the groups other than mean number of drugs, which was 10/patient versus 9.4/control subject (p<0.001). Doses of megestrol acetate ranged from 20-2400 mg/day; 47% received a mean dose of less than 400 mg/day.…”

Section: Case-control Cohort Studymentioning

confidence: 86%

“…For example, in six of 10 reported studies of megestrol use in the elderly, weight change was a primary outcome; in the others, it was a secondary outcome. [34][35][36][37][38][39][40][41][42][43] Furthermore, time points for weight assessment varied. Other end points also varied and included appetite and/or nutritional intake, body composition, laboratory values indicative of nutrition, inflammation or possible adverse effects, quality of life, functional status, and survival.…”

Section: Efficacy In the Treatment Of Weight Loss In The Elderlymentioning

confidence: 99%

Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the Elderly

et al. 2009

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A rising concern among clinicians is treatment of unplanned weight loss in the elderly, especially given the predicted growth of this population over the next few decades. Unexpected weight loss in the geriatric patient worsens overall health outcomes. A variety of pharmacotherapeutic options are available for treatment; however, evidence underlying their use is limited, and none has gained approval from the United States Food and Drug Administration for this indication. At present, no guidelines support the choice of one agent over another. Although several drug interventions have been employed for this problem, megestrol acetate and mirtazapine are becoming increasingly used for appetite stimulation. These drugs represent two feasible options for geriatric patients because of their generally favorable adverse-effect profiles and few drug interactions, but they are often misused. In a comprehensive search of the MEDLINE and International Pharmaceutical Abstracts databases, we identified all published reports on the use of megestrol acetate or mirtazapine for the treatment of weight loss and on any adverse events associated with these drugs. Special emphasis was placed on trials performed in an elderly population. Results were conflicting, most likely because of differing study designs and small numbers of patients. Megestrol acetate and mirtazapine appear to be effective for appetite stimulation and weight gain in some settings. However, applicability of the data to elderly individuals is unclear, and adverse events reported in a few of the trials and in case reports were not benign. Therefore, the use of megestrol acetate or mirtazapine for weight loss should be thoroughly evaluated on an individual basis. Pharmacotherapy should be used only after all underlying causes of weight loss are assessed and treated.

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A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss

Cited by 25 publications

References 44 publications

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up

Progesterone therapy for the treatment of non-cancer cachexia: a systematic review

Megestrol Acetate and Mirtazapine for the Treatment of Unplanned Weight Loss in the Elderly

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