Publication: Efficacy and safety of pharmacological cachexia interventions: Systematic review and network meta-analysis
Issued Date
2021-03-01
Resource Type
ISSN
20454368
2045435X
2045435X
Other identifier(s)
2-s2.0-85097369173
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMJ Supportive and Palliative Care. Vol.11, No.1 (2021), 75-85
Suggested Citation
Manit Saeteaw, Phitjira Sanguanboonyaphong, Jukapun Yoodee, Kaitlyn Craft, Ratree Sawangjit, Nuttapong Ngamphaiboon, Prapimporn Chattranukulchai Shantavasinkul, Suphat Subongkot, Nathorn Chaiyakunapruk Efficacy and safety of pharmacological cachexia interventions: Systematic review and network meta-analysis. BMJ Supportive and Palliative Care. Vol.11, No.1 (2021), 75-85. doi:10.1136/bmjspcare-2020-002601 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78425
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Title
Efficacy and safety of pharmacological cachexia interventions: Systematic review and network meta-analysis
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.