Ruiz Garcia, V., Lopez-Briz, E., Carbonell Sanchis, R., Gonzalvez Perales, J.L., & Bort-Marti, S. (2013). Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database of Systematic Reviews, 3, CD004310.

TYPE OF STUDY:  Meta-analysis and systematic review

DATABASES USED: MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews

KEYWORDS: Extensive keyword and specific search term listing per database is provided.

INCLUSION CRITERIA: Studies were included if they were a randomized controlled trial; reported on patients with weight loss and anorexia-cachexia syndrome due to cancer, HIV, or other disease; and studied use of megestrol acetate (MA) compared  to placebo, to active control, or at different doses.

TOTAL REFERENCES RETRIEVED: N = 950 articles

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Quality and risk of bias were evaluated according to the Cochrane handbook criteria.

FINAL NUMBER STUDIES INCLUDED: N (studies) = 35 studies: 23 trials in cancer, with 3,428 patients

KEY SAMPLE CHARACTERISTICS: Patients with lung, gastrointestinal, head and neck, and gynecologic cancer, as well as unspecified cancer types, were included in the studies.

Patients receiving MA had weight gain (RR = 1.55, 95% CI 1.06–2.66) among trials in patients with cancer. Appetite improved with MA in patients with cancer (RR = 2.57, 95% CI 1.48–4.49). In studies where MA was compared to another active drug, such as a steroid or an antidepressant, in patients with cancer, there was no significant advantage with MA in meta-analysis. There was no apparent impact of higher doses of MA on appetite. There were more adverse events with MA than with placebo, with the most common adverse events being edema and thromboembolism. The quality of evidence for findings related to appetite and weight gain were deemed to be very low, mainly due to high risk of bias.

Findings suggest that MA is effective in improving appetite and resulting in weight gain among patients with cancer; however, findings also show that the quality of evidence was very low. MA did not appear to be more effective than other medications such as steroids.

The quality of evidence was very low.

MA can be effective in improving appetite and weight gain in patients with cancer. Higher doses of MA do not appear to have any greater effect. Nurses should be aware of the possible adverse events associated with MA use, such as thromboembolism. Further research in comparison of risks and benefits of MA in comparison to other medications and strategies to improve appetite and weight gain would be useful.