Appetite stimulants in cystic fibrosis: a systematic review.
BACKGROUND
The use of appetite stimulants in cystic fibrosis (CF) is controversial because of doubts concerning efficacy and side-effects. The aim of the review was to establish whether appetite stimulants should be recommended in CF.


METHODS
Medline, AMED, British Nursing Index, Cinahl, Embase, The Cochrane Library, National Research Register and Google were searched. Unpublished studies, case reports and conference abstracts were sought from experts, including authors of identified published articles, and suppliers of appetite stimulants.


RESULTS
Fifty-four articles were located. Fifteen studies were suitable for inclusion in the review: 10 studied, megesterol acetate (MA); 1, dronabinol; 2, mirtazapine; and 2, cyproheptadine. MA showed a beneficial effect on lung function, weight, appetite, fat free and fat mass. Adverse effects for MA included adrenal suppression, abnormalities of glycaemic control, mood changes and testicular failure. There was no consistency in the dose, frequency and duration of therapy for MA.


CONCLUSIONS
The review shows MA may have a role in the management of anorexia associated with CF. It is not possible to be conclusive for the other agents given the low numbers in the studies. Larger randomized, controlled trials of MA are necessary to confirm its safety and validate efficacy in CF.
Chinuck
R S
RS
Adult Cystic Fibrosis Centre, David Evans Centre, Nottingham University Hospitals, City Campus, Nottingham, UK. ruth.chinuck@nuh.nhs.uk
Fortnum
H
H
Baldwin
D R
DR
D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology; D019167:Appetite Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D001835:Body Weight / Q000187:drug effects; D003533:Cyproheptadine / Q000009:adverse effects / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications*; D013759:Dronabinol / Q000009:adverse effects / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D019290:Megestrol Acetate / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D019167:Appetite Stimulants; D005765:Gastrointestinal Agents; D003533:Cyproheptadine; D013759:Dronabinol; D019290:Megestrol Acetate