Double-blind, randomized, placebo-controlled phase III trial of oxymetholone for the treatment of HIV wasting.
BACKGROUND
Despite highly active antiretroviral therapy (HAART), chronic involuntary weight loss still remains a serious problem in the care of HIV patients. Various alterations in energy metabolism and endocrine regulation have been found to cause loss of lean body mass (LBM) and body cell mass (BCM). Previous studies in HIV-positive men undergoing androgen replacement therapy or treatment with recombinant growth hormone (rGH) have shown partial restoration of LBM, but these treatments have largely been ineffective in eugonadal individuals.


METHODS
Double-blind, randomized, placebo-controlled trial of 89 HIV-positive women and men with wasting assigned to the anabolic steroid oxymetholone [50 mg twice (BID) or three times daily (TID)] or placebo for 16 weeks followed by open-label treatment. STUDY ENDPOINTS: Body weight, bioimpedance measurements, quality of life parameters and appetite.


RESULTS
Oxymetholone led to a significant weight gain of 3.0 +/- 0.5 and 3.5 +/- 0.7 kg in the TID and BID groups, respectively (P < 0.05 for each treatment versus placebo), whereas individuals in the placebo group gained an average of 1.0 +/- 0.7 kg. Body cell mass increased in the oxymetholone BID group (3.8 +/- 0.4 kg; P < 0.0001) and in the oxymetholone TID group (2.1 +/- 0.6 kg; P < 0.005), corresponding to 12.4 and 7.4% of baseline BCM, respectively. Significant improvements were noted in appetite and food intake, increased well-being and reduced weakness by self-examination. The most important adverse event was liver-associated toxicity. Overall, 35% of patients in the TID, 27% of patients in the BID oxymetholone group and no patients in the placebo group had a greater than five times baseline increase for alanine aminotransferase during the double-blind phase of the study.


CONCLUSIONS
Oxymetholone can be considered an effective anabolic steroid in eugonadal male and female patients with AIDS-associated wasting. The BID (100 mg/day) regimen appeared to be equally effective as the TID (150 mg/day) regimen in terms of weight gain, LBM and BCM and was associated with less, but still significant liver toxicity.
Hengge
Ulrich R
UR
STD-Unit, Department of Dermatology and Venerology, University of Essen, Germany. ulrich.hengge@uni-duesseldorf.de
Stocks
Kristin
K
Wiehler
Heidi
H
Faulkner
Sandy
S
Esser
Stefan
S
Lorenz
Christine
C
Jentzen
Walter
W
Hengge
Dagmar
D
Goos
Manfred
M
Dudley
Robert E
RE
Ringham
Gary
G
D000328:Adult; D000368:Aged; D045930:Anabolic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001066:Appetite / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D056486:Chemical and Drug Induced Liver Injury; D004311:Double-Blind Method; D005260:Female; D019247:HIV Wasting Syndrome / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010110:Oxymetholone / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D013739:Testosterone / Q000097:blood; D015430:Weight Gain / Q000187:drug effects
D045930:Anabolic Agents; D013739:Testosterone; D010110:Oxymetholone