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Review
Efficacy and safety of pharmacological cachexia interventions: systematic review and network meta-analysis
  1. Manit Saeteaw1,
  2. Phitjira Sanguanboonyaphong1,
  3. Jukapun Yoodee2,
  4. Kaitlyn Craft3,
  5. Ratree Sawangjit4,
  6. Nuttapong Ngamphaiboon5,
  7. Prapimporn Chattranukulchai Shantavasinkul6,
  8. Suphat Subongkot7 and
  9. Nathorn Chaiyakunapruk3
  1. 1 Division of Pharmacy Practice, Facullty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand
  2. 2 Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
  3. 3 Department of Pharmacotherapy, University of Utah Health, Salt Lake City, Utah, USA
  4. 4 Department of Clinical Pharmacy, Mahasarakham University, Mahasarakham, Thailand
  5. 5 Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  6. 6 Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  7. 7 Division of Clinical Pharmacy, Khon Kaen University Faculty of Pharmaceutical Sciences, Khon Kaen, Thailand
  1. Correspondence to Dr Nathorn Chaiyakunapruk, Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84132, USA; nathorn.chaiyakunapruk{at}utah.edu

Abstract

Aims Randomised controlled trials (RCTs) demonstrated benefits of pharmacological interventions for cachexia in improving weight and appetite. However, comparative efficacy and safety are not available. We conducted a systematic review and network meta-analysis (NMA) to evaluate the relative efficacy and safety of pharmacological interventions for cachexia.

Methods PubMed, EmBase, Cochrane, and ClinicalTrials.gov were searched for RCTs until October 2019. Key outcomes were total body weight (TBW) improvement, appetite (APP) score and serious adverse events. Two reviewers independently extracted data and assessed risk of bias. NMA was performed to estimate weight gain and APP score increase at 8 weeks, presented as mean difference (MD) or standardised MD with 95% CI.

Results 80 RCTs (10 579 patients) with 12 treatments were included. Majority is patients with cancer (7220). Compared with placebo, corticosteroids, high-dose megestrol acetate combination (Megace_H_Com) (≥400 mg/day), medroxyprogesterone, high-dose megestrol acetate (Megace_H) (≥400 mg/day), ghrelin mimetic and androgen analogues (Androgen) were significantly associated with MD of TBW of 6.45 (95% CI 2.45 to 10.45), 4.29 (95% CI 2.23 to 6.35), 3.18 (95% CI 0.94 to 5.41), 2.66 (95% CI 1.47 to 3.85), 1.73 (95% CI 0.27 to 3.20) and 1.50 (95% CI 0.56 to 2.44) kg. For appetite improvement, Megace_H_Com, Megace_H and Androgen significantly improved standardised APP score, compared with placebo. There is no significant difference in serious adverse events from all interventions compared with placebo.

Conclusions Our findings suggest that several pharmacological interventions have potential to offer benefits in treatment of cachexia especially Megace_H and short-term use corticosteroids. Nonetheless, high-quality comparative studies to compare safety and efficacy are warranted for better management of cachexia.

  • cachexia
  • anorexia
  • cancer
  • HIV/AIDS

https://doi.org/10.1136/bmjspcare-2020-002601

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    Footnotes

    • Contributors NC, MS and SS designed and organised research. MS, SS, PS, JY, KC and RS acquired, analysed and interpreted the data. MS, SS, NC, PCS and NN interpreted the data. NC and SS supervised the study. MS, PS and JY performed the statistical analysis. MS, KC, PCS, NN and NC wrote the manuscript. NC, PCS and NN revised the review. All authors contributed toward data analysis, drafting and critically revising the review; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.