Megestrol acetate in patients with AIDS and cachexia

* Objective: To study the effects of a megestrol acetate liquid formulation (800 mg/d) on body weight, body composition, caloric intake, and mental outlook in patients with the acquired immunodeficiency syndrome (AIDS) who had cachexia. * Design: Twelve-week, multicenter, randomized, double-blind, placebo-controlled trial. * Setting: Multiple clinical centers. * Patients: 100 patients with AIDS who had weight loss of 10% or more of ideal body weight were randomly assigned to placebo (n = 48) or megestrol acetate (n = 52). * Measurements: Caloric intake, body weight, body composition, and sense of well-being. * Results: Most patients receiving megestrol acetate had increased caloric intake resulting in body weight gain (mainly fat mass). From baseline to week 8, the megestrol acetate group increased their daily caloric intake by 608 calories, whereas the placebo group increased intake by 134 calories (difference, 474 calories; 95% CI, -68 to 880 calories). Body weight in the megestrol acetate group increased by 3.86 kg from baseline to week 8, although it decreased by 0.46 kg in the placebo group (difference, 4.32 kg; CI, 2.42 to 6.22 kg). At week 8 in the megestrol acetate group, patients gained 3.68 kg in fat mass and those in the placebo group lost 0.28 kg (difference, 3.96 kg; CI, 2.49 to 5.43 kg). Body water, lean mass, and patient survival were not statistically different between treatment groups. Patients treated with megestrol acetate had an increased sense of well-being when compared with patients who received placebo. * Conclusions: This megestrol acetate liquid formulation is well tolerated, increases food intake, results in body weight gain, and improves the sense of well-being in cachectic patients with AIDS.
Megestrol acetate may be an effective treatment for cachexia in AIDS patients. Cachexia is a state of ill health and malnutrition that can result from weakness and loss of appetite and can lead to wasting. Megestrol acetate is a synthetic hormone that stimulates appetite. Among 42 AIDS patients with cachexia who completed a 12-week study, 22 received 800 milligrams of megestrol acetate daily and 20 took a placebo. By the end of the study, patients taking megestrol acetate had increased daily caloric intake by 447 calories, compared to patients in the placebo group whose intake had decreased by 241 calories relative to the beginning of the study. Body weight increased among the megestrol acetate group and decreased among the placebo group. More patients who took megestrol acetate reported an improvement in well-being than patients who took placebo. Side effects of megestrol acetate included diarrhea, flatulence, weakness, impotence and general pain.