Talebi Sepide, Zeraattalab-Motlagh Sheida, Barkhordar Maryam, Vaezi Mohammad, Ghoreishy Seyed Mojtaba, Ghavami Abed, Hosseini Yasaman, Travica Nikolaj, Mohammadi Hamed
Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1254-1263. doi: 10.1002/jcsm.13500. Epub 2024 Jun 20.
There is inconsistent evidence relating to the effects of megestrol acetate (MA) supplementation on cancer patients suffering from anorexia-cachexia syndrome. This review aimed to examine the dose-response effect of MA supplementation in patients with cancer-associated anorexia/cachexia. Relevant keywords were searched in PubMed, Scopus and ISI Web of Science from inception to June 2023 for randomized controlled trials (RCTs) examining the effect of MA on pathologies in patients with cancer-associated cachexia. Our primary outcomes were changes in body weight and appetite. However, fatigue and quality of life were secondary outcomes. The mean difference (MD) and 95% confidence interval (95% CI) were estimated using the random-effects method. Thirteen trials comprising 1229 participants (mean age 60 years) were identified. The results of our highest versus lowest analysis revealed that MA supplementation was not associated with any increase in body weight (MD: 0.64 kg, 95% CI [-0.11, 1.38], P = 0.093, I = 69.1%; GRADE = very low certainty). Twelve trials, including 14 effect sizes derived from 1369 patients (intervention = 689, control = 680), provided data on the effect of MA on body weight. Subgroup analyses showed a significant increase in body weight following short-term intervention (≤8 weeks) and a combination of radiation/chemotherapy as concurrent treatment. A linear dose-response meta-analysis indicated that each 200 mg/day increment in MA consumption had a significant increase in weight gain (MD: 0.44; 95% CI [0.13, 0.74], P = 0.005; I = 97.1%); however, the magnitude of the effect was small. MA administration significantly affected the quality of life based on pooled effect sizes (MD: 1.15, 95% CI [0.76, 1.54], P < 0.001, I = 0%; n = 2 RCTs including 176 patients; GRADE = very low certainty). However, no significant effect of MA supplementation was observed on appetite (MD: 0.29, 95% CI [-0.05, 0.64], P = 0.096, I = 18.3%; n = 3 RCTs including 163 patients; GRADE = very low certainty) and fatigue (MD: 0.14, 95% CI [-0.09, 0.36], P = 0.236, I = 0%; n = 2 RCTs including 300 patients; GRADE = very low certainty). With very low certainty of the evidence, MA supplementation may not lead to a significantly increased weight gain and other outcomes.
关于醋酸甲地孕酮（MA）补充剂对患有厌食 - 恶病质综合征的癌症患者的影响，证据并不一致。本综述旨在研究MA补充剂在癌症相关性厌食/恶病质患者中的剂量反应效应。从创刊到2023年6月，在PubMed、Scopus和ISI Web of Science中检索了相关关键词，以查找检验MA对癌症相关性恶病质患者病理影响的随机对照试验（RCT）。我们的主要结局是体重和食欲的变化。然而，疲劳和生活质量是次要结局。使用随机效应方法估计平均差（MD）和95%置信区间（95%CI）。共确定了13项试验，包括1229名参与者（平均年龄60岁）。我们的最高剂量与最低剂量分析结果显示，MA补充剂与体重增加无关（MD：0.64kg，95%CI[-0.11,1.38]，P = 0.093，I = 69.1%；GRADE = 极低确定性）。12项试验（包括从1369名患者得出的14个效应量，干预组 = 689，对照组 = 680）提供了MA对体重影响的数据。亚组分析显示，短期干预（≤8周）以及放疗/化疗联合作为同期治疗后体重显著增加。线性剂量反应荟萃分析表明，MA摄入量每增加200mg/天，体重增加显著（MD：0.44；95%CI[0.13,0.74]，P = 0.005；I = 97.1%）；然而，效应幅度较小。基于合并效应量，MA给药对生活质量有显著影响（MD：1.15，95%CI[0.76,1.54]，P < 0.001，I = 0%；n = 2项RCT，包括176名患者；GRADE = 极低确定性）。然而，未观察到MA补充剂对食欲有显著影响（MD：0.29，95%CI[-0.05,0.64]，P = 0.096，I = 18.3%；n = 3项RCT，包括163名患者；GRADE = 极低确定性）和疲劳（MD：0.14，95%CI[-0.09,0.36]，P = 0.236，I = 0%；n = 2项RCT，包括300名患者；GRADE = 极低确定性）。由于证据确定性极低，MA补充剂可能不会导致体重显著增加及其他结局。
