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Megestrol Acetate in Patients with AIDS and Cachexia

Michelle H. Oster, PhD, RD; Sheila R. Enders, BS; Steven J. Samuels, PhD; Lawrence A. Cone, MD; Thomas M. Hooton, MD; Henry P. Browder, PhD; and Neil M. Flynn, MD
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From the University of California at Davis, Davis, California; Eisenhower Medical Center, Rancho Mirage, California; Harborview Medical Center, Seattle, Washington; Bristol-Myers Squibb, Plainsboro, New Jersey. Requests for Reprints: Neil M. Flynn, MD, Division of General Medicine, University of California Davis Medical Center, 2221 Stockton Boulevard, PCC Room 3107, Sacramento, CA 95817. Acknowledgments: The authors thank all of the clinicians, study coordinators, and dietitians who worked on this project. The following clinicians and institutions participated in the megestrol acetate trial: Eric Goosby, MD, and James Kahn, MD (San Francisco General Hospital, San Francisco, California); Patrick Joseph, MD (Peralta Hospital, Oakland, California); Carl Grunfeld, MD, PhD (Veterans Affairs Medical Center, San Francisco, California); Nancy G. Klimas, MD (Veterans Affairs Medical Center, Miami, Florida); Jamie Von Roenn, MD (Northwestern University Medical School, Chicago, Illinois); David L. Cohn, MD (Public Health Department, Denver, Colorado); John Toney, MD (University of South Florida, Tampa, Florida); Donald Armstrong, MD (Memorial Sloan-Kettering Cancer Center, New York, New York); Mark Goldstein, MD (Keith Medical Group, Los Angeles, California); and Dennis Israelski, MD (Veterans Affairs Hospital, Palo Alto, California). Grant Support: Supported by Bristol-Myers Squibb.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(6):400-408. doi:10.7326/0003-4819-121-6-199409150-00002
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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.


Grahic Jump Location
Figure 1.
Effect of megestrol acetate and placebo on survival from start of study. P

> 0.82 for test of equality of survival curves. MA = megestrol acetate.

Grahic Jump Location




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