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Correspondence to Dr Nathorn Chaiyakunapruk, Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84132, USA; [email protected]
Key messages
What is already known about this subject
Cachexia is a complex wasting syndrome affecting patients with chronic disease (cancer and HIV) that is associated with decreased survival, health-related quality of life and increased treatment toxicities. A number of pharmacological interventions have been investigated in recent randomised controlled trials (RCTs) and have demonstrated benefits for cachexia in improving weight and appetite. However, their comparative efficacy and safety for management of cachexia have not been thoroughly investigated.
What this study adds
Single and comprehensive framework for comparison of efficacy and safety outcomes among various pharmacological treatments for cachexia.
The present review combines direct and indirect evidence from 80 RCTs (10 579 patients) to estimate weight gain, change in appetite score and adverse events using different pharmacological agents for management of cachexia, excluding nutritional interventions and dietary supplement.
High-dose megestrol acetate and short-term use of corticosteroids offer benefit in the treatment of cachexia.
This study suggests that anamorelin has high potential in cachexia treatment and recommends further investigation into this pharmacological agent.
Introduction
Cachexia is a complex wasting syndrome associated with many chronic diseases, such as cancer, HIV and chronic obstructive pulmonary disease (COPD).1 It is characterised by involuntary loss of skeletal muscle mass (with or without loss of fat mass), asthenia and systemic inflammation resulting from an imbalance of metabolic demands and energy uptake.1 2 The prevalence of cachexia is high, affecting 5%–15% of patients with COPD and 60%–80% of patients with advanced cancer.3 Cachexia plays an important role in the morbidity and mortality of these patients, resulting in decreased survival, health-related quality of life and increased treatment side effects.4
Effective treatment for cachexia requires early identification and multimodal intervention, including optimal disease therapy, symptom management, targeted exercise and nutritional support.4–6 Treatment for cachexia has largely focused on non-pharmacological strategies. Nutritional support may prevent and treat cachexia; however, it cannot be fully reversed by conventional nutritional intervention. The 2016 European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on nutrition in patients with advanced cancer recommend early nutrition screening and assessment to detect patients with malnutrition and suggest stepwise nutritional...