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A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss.
Am J Geriatr Pharmacother. 2007 Jun; 5(2):137-46.AJ

Abstract

BACKGROUND

Megestrol acetate (MA) is a progestin widely used to treat weight loss and cachexia in patients suffering from AIDS or cancer. Although MA is also frequently prescribed for similarly malnourished elderly individuals, the efficacy and morbidity of MA treatment in this patient population remain unclear.

OBJECTIVE

The goal of this study was to examine the effects of MA therapy on weight and overall mortality in elderly nursing home residents.

METHODS

This was a case-control cohort study of 17,328 nursing home residents admitted to Beverly Healthcare nursing home between January 1, 2000, and December 31, 2003, who had lost either 5% of total body weight within 3 months or 10% of total body weight within 6 months. Residents within this weight loss group who received MA therapy--within 30 days of their weight loss documentation--were matched (1:2) with non-MA-treated residents with respect to age, sex, race, weight, and first notation of weight loss. Residents were further matched by propensity score for activities of daily living, cognitive functioning, number of medications taken during the 7 days before data entry, clinical condition (unstable, acute episode of a recurrent problem, end-stage disease), cancer diagnosis, and human immunodeficiency virus diagnosis.

RESULTS

A total of 709 patients (mean [SD]age, 84.1 [9.7]years; 70.9% female) who received MA therapy were matched with 1418 non-MA-treated patients (mean [SD] age, 84.2 [9.0] years; 70.9% female). Of the 709 MA patients, 281 (39.6%) were alive and in the nursing home at last follow-up, 149 (21.0%) were alive and discharged to another facility or to home, and 279 (39.4%) died in the nursing home. For the controls, 651 (45.9%) were alive and in the nursing home, 308 (21.7%) were discharged to another facility or to home, and 459 (32.4%) died in the nursing home. The median survival of MA-treated residents (23.9 months; 95% CI, 20.2-27.5) was significantly less than untreated residents (31.2 months; 95% CI, 27.8-35.9) (P < 0.001). Median weight and median of weight differences were unchanged after 6 months of treatment with MA compared with matched controls.

CONCLUSIONS

MA treatment of elderly nursing home residents with significant weight loss was associated with a significant increase in all-cause mortality without a significant increase in weight. Randomized, prospective studies of the use of MA in elderly nursing home residents are necessary to more fully evaluate morbidity and mortality associated with this therapy.

Authors+Show Affiliations

University of Arkansas for Medical Sciences, Department of Geriatrics, Little Rock, Arkansas 72205, USA. bodennerdonald@uams.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17719516

Citation

Bodenner, Donald, et al. "A Retrospective Study of the Association Between Megestrol Acetate Administration and Mortality Among Nursing Home Residents With Clinically Significant Weight Loss." The American Journal of Geriatric Pharmacotherapy, vol. 5, no. 2, 2007, pp. 137-46.
Bodenner D, Spencer T, Riggs AT, et al. A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss. Am J Geriatr Pharmacother. 2007;5(2):137-46.
Bodenner, D., Spencer, T., Riggs, A. T., Redman, C., Strunk, B., & Hughes, T. (2007). A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss. The American Journal of Geriatric Pharmacotherapy, 5(2), 137-46.
Bodenner D, et al. A Retrospective Study of the Association Between Megestrol Acetate Administration and Mortality Among Nursing Home Residents With Clinically Significant Weight Loss. Am J Geriatr Pharmacother. 2007;5(2):137-46. PubMed PMID: 17719516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss. AU - Bodenner,Donald, AU - Spencer,Trey, AU - Riggs,Ann T, AU - Redman,Carolyn, AU - Strunk,Billy, AU - Hughes,Tony, PY - 2007/01/03/accepted PY - 2007/8/28/pubmed PY - 2007/9/19/medline PY - 2007/8/28/entrez SP - 137 EP - 46 JF - The American journal of geriatric pharmacotherapy JO - Am J Geriatr Pharmacother VL - 5 IS - 2 N2 - BACKGROUND: Megestrol acetate (MA) is a progestin widely used to treat weight loss and cachexia in patients suffering from AIDS or cancer. Although MA is also frequently prescribed for similarly malnourished elderly individuals, the efficacy and morbidity of MA treatment in this patient population remain unclear. OBJECTIVE: The goal of this study was to examine the effects of MA therapy on weight and overall mortality in elderly nursing home residents. METHODS: This was a case-control cohort study of 17,328 nursing home residents admitted to Beverly Healthcare nursing home between January 1, 2000, and December 31, 2003, who had lost either 5% of total body weight within 3 months or 10% of total body weight within 6 months. Residents within this weight loss group who received MA therapy--within 30 days of their weight loss documentation--were matched (1:2) with non-MA-treated residents with respect to age, sex, race, weight, and first notation of weight loss. Residents were further matched by propensity score for activities of daily living, cognitive functioning, number of medications taken during the 7 days before data entry, clinical condition (unstable, acute episode of a recurrent problem, end-stage disease), cancer diagnosis, and human immunodeficiency virus diagnosis. RESULTS: A total of 709 patients (mean [SD]age, 84.1 [9.7]years; 70.9% female) who received MA therapy were matched with 1418 non-MA-treated patients (mean [SD] age, 84.2 [9.0] years; 70.9% female). Of the 709 MA patients, 281 (39.6%) were alive and in the nursing home at last follow-up, 149 (21.0%) were alive and discharged to another facility or to home, and 279 (39.4%) died in the nursing home. For the controls, 651 (45.9%) were alive and in the nursing home, 308 (21.7%) were discharged to another facility or to home, and 459 (32.4%) died in the nursing home. The median survival of MA-treated residents (23.9 months; 95% CI, 20.2-27.5) was significantly less than untreated residents (31.2 months; 95% CI, 27.8-35.9) (P < 0.001). Median weight and median of weight differences were unchanged after 6 months of treatment with MA compared with matched controls. CONCLUSIONS: MA treatment of elderly nursing home residents with significant weight loss was associated with a significant increase in all-cause mortality without a significant increase in weight. Randomized, prospective studies of the use of MA in elderly nursing home residents are necessary to more fully evaluate morbidity and mortality associated with this therapy. SN - 1543-5946 UR - https://www.unboundmedicine.com/medline/citation/17719516/A_retrospective_study_of_the_association_between_megestrol_acetate_administration_and_mortality_among_nursing_home_residents_with_clinically_significant_weight_loss_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1543-5946(07)00027-X DB - PRIME DP - Unbound Medicine ER -