Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 399

Various orexigenic stimulants to improve body weight have been studied. Corticosteroids have improved appetite but have not demonstrated a gain in body weight in clinical trials. Cyproheptadine has been shown to increase appetite in cancer patients without weight gain. Cannabinoids (dronabinol, marinol, and nabilone) have shown promise in improving mood and appetite in cancer patients and AIDS cachexia. Thalidomide, a tumour necrosis factor inhibitor, has produced body weight gain in a small number of patients with HIV‐associated wasting syndrome.

Of the pharmacological agents demonstrated to produce weight gain in patients with anorexia and cachexia, megestrol acetate has been the most widely studied agent. In a meta‐analysis of 26 trials, megestrol acetate was found to increase appetite, produce weight gain, and improve health‐related quality of life in oncology patients, compared with placebo. In AIDS patients, increased weight was demonstrated. Only oedema was significant as an adverse event.⁸⁶

Steroids and hormonal agents such as megestrol acetate are currently widely used in the treatment of cachexia and anorexia. They act through multiple pathways, such as increasing neuropeptide‐Y levels to increase appetite and downregulating proinflammatory cytokines. Pharmacological treatment of anorexia with agents that modulate cytokine production may produce weight gain in cachexia states. The action of thalidomide has been linked to inhibition and degradation of TNF‐α.⁸⁷ The results of these pharmacological trials raise the interesting hypothesis that the improvement in appetite and weight gain may be related to their effect on cytokines.