Progesterone therapy for the treatment of non-cancer cachexia: a systematic review.
BACKGROUND
Cachexia describes a complex pathological syndrome of muscle wasting, anorexia and weight loss. Progesterone therapies have been shown to improve appetite and promote weight gain in patients with cachexia; however, research has focused heavily on patients with cancer, and its effectiveness in other diseases remains unclear.


OBJECTIVE
This systematic review aimed to present the evidence available for progesterone therapy as a treatment for non-cancer cachexia.


METHODS
Surrogate outcome measures used were weight change, lean body mass (LBM), muscle strength, appetite, health-related quality of life (HRQOL) and serum albumin. Both randomised and non-randomised trials were included. A literature search of clinical trials using the medical subject heading (MeSH) terms 'cachexia' OR 'anorexia' OR 'weight' OR 'frail (truncated)' OR 'appetite' OR 'wasting syndrome' PLUS 'megestrol acetate' OR 'medroxyprogesterone acetate' was performed.


RESULTS
Eighteen studies were included in this review; 12 randomised control trials and 6 non-randomised trials. This collated results from 916 patients with HIV/AIDS, end-stage renal failure, chronic obstructive pulmonary disease (COPD) and geriatric cachexia. Meta-analysis comparing progesterone therapy with placebo concluded mean change in weight was not significant (mean difference (MD) 1.56, 95% CI -0.36 to 3.52, p=0.12). There was little evidence to show significant impact on LBM, and no trials looked at muscle strength. There was a paucity of evidence looking at appetite and HRQOL; however, results were generally positive.


CONCLUSIONS
Current evidence does not support the use of progesterone therapies for non-cancer cachexia. There may however be a limited role for its use as an appetite stimulant in a palliative context on a case-by-case basis.
East Lancashire Hospitals NHS Trust, Blackburn, UK.
Joanne K
JK
Taylor
Centre for Clinical and Cognitive Neurosciences, Institute of Brain, Behaviour and Mental Health, Salford Royal Hospital, Salford, UK.
Neil
N
Pendleton
D001835:Body Weight / Q000187:drug effects; D002100:Cachexia / Q000188:drug therapy*; D006801:Humans; D011374:Progesterone / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D011374:Progesterone
Chronic conditions; HIV/AIDS; Quality of life; Renal failure