目的:随机对照试验(RCT)证明药物干预恶病质在改善体重和食欲方面的益处。然而,没有比较的疗效和安全性。我们进行了系统评价和网络荟萃分析(NMA),以评估药物干预治疗恶病质的相对有效性和安全性。
方法:PubMed,Embase,科克伦,和ClinicalTrials.gov搜索RCT,直到2019年10月。主要结果是总体重(TBW)改善,食欲(APP)评分和严重不良事件。两名评审员独立提取数据并评估偏倚风险。在8周时进行NMA以估计体重增加和APP评分增加,以平均差(MD)或标准化MD表示,95%CI。
结果:包括80例RCTs(10579例)和12种治疗方法。大多数是癌症患者(7220)。与安慰剂相比,皮质类固醇,大剂量醋酸甲地孕酮组合(Megace_H_Com)(≥400mg/天),甲羟孕酮,高剂量醋酸甲地孕酮(Megace_H)(≥400mg/天),生长素释放肽模拟物和雄激素类似物(雄激素)与TBW的MD为6.45(95%CI2.45至10.45)显着相关,4.29(95%CI2.23至6.35),3.18(95%CI0.94至5.41),2.66(95%CI1.47至3.85),1.73(95%CI0.27至3.20)和1.50(95%CI0.56至2.44)kg。为了改善食欲,Megace_H_Com,Megace_H和Androgen显著提高了标准化APP评分,与安慰剂相比。与安慰剂相比,所有干预措施的严重不良事件没有显着差异。
结论:我们的研究结果表明,几种药物干预措施有可能在恶病质的治疗中提供益处,尤其是Megace_H和短期使用皮质类固醇。尽管如此,为了更好地管理恶病质,需要进行高质量的比较研究来比较安全性和有效性.
OBJECTIVE: Randomised controlled trials (RCTs) demonstrated benefits of pharmacological interventions for cachexia in improving weight and appetite. However, comparative efficacy and safety are not available. We conducted a systematic
review and network meta-analysis (NMA) to evaluate the relative efficacy and safety of pharmacological interventions for cachexia.
METHODS: PubMed, EmBase, Cochrane, and ClinicalTrials.gov were searched for RCTs until October 2019. Key outcomes were total body weight (TBW) improvement, appetite (APP) score and serious adverse events. Two reviewers independently extracted data and assessed risk of bias. NMA was performed to estimate weight gain and APP score increase at 8 weeks, presented as mean difference (MD) or standardised MD with 95% CI.
RESULTS: 80 RCTs (10 579 patients) with 12 treatments were included. Majority is patients with cancer (7220). Compared with placebo, corticosteroids, high-dose megestrol acetate combination (Megace_H_Com) (≥400 mg/day),
medroxyprogesterone, high-dose megestrol acetate (Megace_H) (≥400 mg/day), ghrelin mimetic and androgen analogues (Androgen) were significantly associated with MD of TBW of 6.45 (95% CI 2.45 to 10.45), 4.29 (95% CI 2.23 to 6.35), 3.18 (95% CI 0.94 to 5.41), 2.66 (95% CI 1.47 to 3.85), 1.73 (95% CI 0.27 to 3.20) and 1.50 (95% CI 0.56 to 2.44) kg. For appetite improvement, Megace_H_Com, Megace_H and Androgen significantly improved standardised APP score, compared with placebo. There is no significant difference in serious adverse events from all interventions compared with placebo.
CONCLUSIONS: Our findings suggest that several pharmacological interventions have potential to offer benefits in treatment of cachexia especially Megace_H and short-term use corticosteroids. Nonetheless, high-quality comparative studies to compare safety and efficacy are warranted for better management of cachexia.