Thursday, January 25, 2007

Megace makes you fat and weak

From the latest Journal of the American Geriatrics Society...

1)
Megace makes you fat and weak. Which is a crude, sensationalistic way of saying that in a small randomized trial looking at muscle strength and function those taking megestrol acetate (MA) had worse outcomes than those taking placebo. The findings come from a study looking at progressive resistance muscle strength training (PRMST) and MA in elderly people with an acute functional decline after an illness--to see if these promoted speedier/better recovery. This was a small study involving 29 people who were followed for 12 weeks; they were randomized independently to 800mg MA daily or placebo and PRMST or some sort of low-resistance muscle exercise regimen. Most of the outcomes were non-clinical (standardized muscle strength/performance characteristics, etc.). The findings were:

a) Patients performing PRMST improved substantially more than the patients doing the other exercises. (Details on what PRMST entails are in the article).

b) Patients receiving MA all around did worse: it attenuated or nullified improvements from PRMST, muscle strength went down or didn't improve, and aggregate physical functioning scores worsened in patients receiving MA. Weight-wise, the findings were consistent with what is known about MA: weight went up a little--all fat--& muscle mass didn't change at all.

Despite the small numbers, most of the damning findings for MA achieved statistical significance (highlighting just how profoundly poorer the MA subjects did). That said, it's tough to get super-excited about such a small study, unless you're a MA skeptic looking for another reason not to use this drug (ahem). It should also be noted that this is a substantially different look at MA than how it's been evaluated in advanced cancer patients, for which there is indeed evidence it increases appetite and leads to a small amount of weight (fat, not muscle) gain--and equivocal evidence it improves quality of life (a few patients, certainly, seem to love it). This study, however, raises the spectre that MA may actually be doing harm in frail, elderly patients.

2)
Confirmatory evidence that poor motor function is associated with worse prognosis in the elderly. I'm not going to comment on this much but it might be of interest to those of you who track these things.

3)
And a footnote to Christian's recent post on Art Buchwald's death: a nice, pro-hospice article from the NY Times by Jane Brody (who frequently writes about end of life issues, usually pretty reasonably). Thanks to Tom Quinn for alerting me to this.

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