A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss.
BACKGROUND
Megestrol acetate (MA) is a progestin widely used to treat weight loss and cachexia in patients suffering from AIDS or cancer. Although MA is also frequently prescribed for similarly malnourished elderly individuals, the efficacy and morbidity of MA treatment in this patient population remain unclear.


OBJECTIVE
The goal of this study was to examine the effects of MA therapy on weight and overall mortality in elderly nursing home residents.


METHODS
This was a case-control cohort study of 17,328 nursing home residents admitted to Beverly Healthcare nursing home between January 1, 2000, and December 31, 2003, who had lost either 5% of total body weight within 3 months or 10% of total body weight within 6 months. Residents within this weight loss group who received MA therapy--within 30 days of their weight loss documentation--were matched (1:2) with non-MA-treated residents with respect to age, sex, race, weight, and first notation of weight loss. Residents were further matched by propensity score for activities of daily living, cognitive functioning, number of medications taken during the 7 days before data entry, clinical condition (unstable, acute episode of a recurrent problem, end-stage disease), cancer diagnosis, and human immunodeficiency virus diagnosis.


RESULTS
A total of 709 patients (mean [SD]age, 84.1 [9.7]years; 70.9% female) who received MA therapy were matched with 1418 non-MA-treated patients (mean [SD] age, 84.2 [9.0] years; 70.9% female). Of the 709 MA patients, 281 (39.6%) were alive and in the nursing home at last follow-up, 149 (21.0%) were alive and discharged to another facility or to home, and 279 (39.4%) died in the nursing home. For the controls, 651 (45.9%) were alive and in the nursing home, 308 (21.7%) were discharged to another facility or to home, and 459 (32.4%) died in the nursing home. The median survival of MA-treated residents (23.9 months; 95% CI, 20.2-27.5) was significantly less than untreated residents (31.2 months; 95% CI, 27.8-35.9) (P < 0.001). Median weight and median of weight differences were unchanged after 6 months of treatment with MA compared with matched controls.


CONCLUSIONS
MA treatment of elderly nursing home residents with significant weight loss was associated with a significant increase in all-cause mortality without a significant increase in weight. Randomized, prospective studies of the use of MA in elderly nursing home residents are necessary to more fully evaluate morbidity and mortality associated with this therapy.
Bodenner
Donald
D
University of Arkansas for Medical Sciences, Department of Geriatrics, Little Rock, Arkansas 72205, USA. bodennerdonald@uams.edu
Spencer
Trey
T
Riggs
Ann T
AT
Redman
Carolyn
C
Strunk
Billy
B
Hughes
Tony
T
D000368:Aged; D000855:Anorexia / Q000188:drug therapy / Q000401:mortality; D019167:Appetite Stimulants / Q000009:adverse effects*; D002100:Cachexia / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D019290:Megestrol Acetate / Q000009:adverse effects*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000187:drug effects* / Q000502:physiology*
D019167:Appetite Stimulants; D019290:Megestrol Acetate