Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome

This study aimed to assess the efficacy and safety of megestrol acetate (MA) in anorexia-cachexia syndrome (A CS). Literature and relevant databases were searched for randomized controlled trials of MA to treat A CS in patients with cancer, AIDS, or other pathologies. Data were extracted by two independent reviewers, and meta-analyses were performed where possible. Twenty-six studies were included (n = 3,887). Compared to placebo, MA increased appetite in oncology patients [RR = 2.31 (95% CI 1.52-3.59)], led to weight gain [RR = 1.88 (95% CI 1.43-2.47)] and improved HRQOL [RR = 1.52 (95% CI 1.00-2.30)]. In AIDS patients, it increased weight [RR = 2.16 (95% CI 1.45-3.21)]. MA showed significant benefits over dronabinol in improving appetite, but no statistically significant advantages over other drugs for treating A CS were observed. There were no appreciable differences between lower (< 800 mg/day) and higher (> 800 mg/day) doses of MA. Few serious adverse events were recorded. MA is an effective and safe treatment for A CS in cancer and AIDS patients, particularly in terms of improvement in appetite and weight gain. (C) 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.