นโยบายงานวิจัย /จรรยาบรรณนักวิจัย /ระดับคุณภาพบทความวิจัยตีพิมพ์ /ระดับคุณภาพผลงานวิชาการ /แหล่งทุน /ดาวน์โหลด /ฐานข้อมูลวิจัย /วิเคราะห์-สังเคราะห์งานวิจัย /ลิขสิทธิ์ /ข่าว


Comparative efficacy and safety of Pharmacologic interventions for cachexia: A systematic review and network  meta‐analysis


Author

-

M. Sae‐Teaw, S. Subongkot, N. Chaiyakunapruk


Journal

- ESMO Asia 2017 Congress

Volume

- 0

Year

- 2017

Publication type

-

Page list

- -

Abstract

   

Recent randomized clinical trials (RCTs) have demonstrated benefits of various pharmacologic interventions for  cachexia in improving weight and appetite. However, their comparative efficacy and safety are not available.  Therefore, we conduct a systematic review and network‐meta‐analysis to evaluate the relative efficacy and safety  of the pharmacologic interventions for cachexia.  PubMed, EmBase, Cochrane, and ClincalTrials.gov were searched for RCTs until October 2016. Key outcomes were  total body weight (TBW) improvement and appetite (APP) score and serious adverse events. Two reviewers  independently extracted data and assessed risk of bias of all RCTs. Network meta‐analysis was performed to  estimate relative magnitude of weight gain and appetite score increased at 8 weeks of all interventions, presented  as mean difference (MD) or standardized mean difference with 95% confidence interval (CI). To rank the  intervention hierarchy in the network meta‐analysis, the rankograms, surface under the cumulative ranking  (SUCRA) curves, and mean ranks were estimated.  73 RCTs involving 9,615 patients with 12 therapeutic options were included. Majority is cancer patients (6,335),  while 2,324 were HIV patients. Compared to placebo, corticosteroids, megace‐H‐com, megace‐H and androgen  were significantly associated with MD of TBW of 6.23 (95%CI 1.91, 10.56), 3.73 (95%CI 1.58, 5.88), 2.80 (95%CI  1.46, 4.13) and 1.47 (95%CI 0.31, 2.63) kg, respectively. For appetite improvement, megace‐L, megace‐H,  medroxyprogesterone, androgen, megace‐H‐com, and ghrelin mimetics had significantly improved standardized  APP score, compared to placebo. These score improvements were also reported earlier than 8 weeks in most  appetite stimulants (ghrelin, megace‐L, megace‐H, and medroxyprogesterone). There is no significantly difference  in serious ADRs as compared to the placebo.   This network meta‐analysis suggests that appetite stimulants may offer superior benefits in the treatment of  cachexia. Nonetheless, the comparative studies to compare safety and efficacy is warranted to better manage  cachexia.  


Keywords

   

Cachexia, weight loss, appetite stimulants