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

Abstract

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.

A randomised, double blind, placebo-controlled trial of megestrol acetate or dexamethasone in treating symptomatic anorexia in people with advanced cancer

“…Other studies of megestrol and dexamethasone for the treatment of cancer-related anorexia have reported similar degrees of appetite stimulation in participants treated with dexamethasone 0•75 mg four times daily compared to megestrol acetate 800 mg daily, again with non-significant findings, but as with the current study the direction of benefit was in favour of megestrol 24 , as was one systematic review 40 .…”