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Progesterone therapy for the treatment of non-cancer cachexia: a systematic review
  1. Joanne K Taylor1 and
  2. Neil Pendleton2
  1. 1East Lancashire Hospitals NHS Trust, Blackburn, UK
  2. 2Centre for Clinical and Cognitive Neurosciences, Institute of Brain, Behaviour and Mental Health, Salford Royal Hospital, Salford, UK
  1. Correspondence to Dr Joanne K Taylor; joanne.taylor111{at}gmail.com

Abstract

Background Cachexia 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.

Aims This systematic review aimed to present the evidence available for progesterone therapy as a treatment for non-cancer cachexia.

Method Surrogate 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.

Results Eighteen 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.

Conclusions Current 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.

  • Chronic conditions
  • Quality of life
  • HIV/AIDS
  • Renal failure
  • Received 13 October 2015.
  • Revision received 18 January 2016.
  • Accepted 4 April 2016.

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  • Received 13 October 2015.
  • Revision received 18 January 2016.
  • Accepted 4 April 2016.
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