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 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.

Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database

“…were not fully captured as these do not require a prescription. The use of megesterol and dronabinol in cases compared to controls is consistent with clinical efforts to manage this cachexia and weight loss [27,28]. In addition, cases having ICD codes were more likely to receive directed pharmacological treatments.…”

Pancreatic Cancer and Cachexia—Metabolic Mechanisms and Novel Insights

“…Progestogens, such as megestrol acetate (MA) and corticosteroids, are used as orexigenic agents [62]. Their mechanism of action is through the inhibition of cytokines and restoration of appetite, resulting in weight gain, as seen in recent animal and human models [63], but not always accompanied by respective improvements in quality of life in humans [64].…”

Megestrol Acetate Induced Paradoxical Embolism in a Sickle Cell Disease Patient

“…We present a unique case of a patient with previously well-controlled SCD, and no significant history of sickle cell crises, who presented three days after initiating megestrol acetate with a paradoxical embolic stroke in the setting of an unknown PFO. Megestrol acetate is a progestin derivative with anti-estrogenic properties often used as an appetite stimulant in certain patient populations, such as those suffering from cancer and other terminal illnesses [6]. However, it is associated with a common adverse effect of thromboembolic events and is, therefore, used with caution in patient populations with increased risk of clots.…”

“…Due to the disease’s inherent thrombophilic state, previous studies have evaluated the safety of progestin-only contraceptives and combined oral contraception in women with SCD. Megestrol acetate is a synthetic derivative of progesterone commonly used to treat anorexia and cachexia in patients suffering from cancer, AIDS, anorexia, and other terminal illnesses [6]. It has also been used in­­ the past as a contraceptive option, though less commonly used.…”