Fifty-five RCTs (n=6,741) were included in the review.
The Jadad scores for quality ranged from 1 to 5.
Progestins (29 RCTs, n=4,139). MA (23 studies): patients treated with MA showed improvements compared with those taking placebo (of 10 placebo-controlled RCTs, nine reported significant improvements in appetite and seven reported significant improvements in weight). The review authors described side-effects associated with MA as 'acceptable' but no data were reported. There was very little effect of MA on quality of life (10 RCTs).
MPA (6 studies): patients treated with oral MPA showed improvements compared with those taking placebo (of 6 placebo-controlled RCTs, four reported significant improvements in appetite and five reported significant improvements in weight). The review authors described side-effects associated with MPA as 'acceptable' but no data were reported. Two of the 3 RCTs assessing quality of life reported improvements in quality of life associated with MPA; the other study reported no measurable benefit.
Corticosteroids (6 RCTs, n=647).
Intravenous MPSS: 2 RCTs evaluated intravenous 125 mg/day MPSS for 8 weeks and reported improvements in appetite, pain, quality of life, vomiting and well-being, as well as a temporary improvement in appetite, compared with placebo. One of the RCTs assessed weight and found no treatment difference.
MP: one crossover RCT evaluated oral 32 mg/day MP for 14 days and reported improvements in appetite and performance status compared with placebo.
Prednisolone: one RCT evaluated 10 mg/day prednisolone for 6 weeks and reported significant improvements in appetite and well-being compared with placebo.
Dexamethasone: 2 placebo-controlled RCTs evaluated 3 to 8 mg/day dexamethasone. One reported significant improvements in weight of unclear onset and duration compared with placebo (table stated the improvement was at 4 weeks but not 2 weeks, whilst the text stated the improvement was at 2 weeks but not at 4 weeks); the other reported no significant treatment difference in appetite.
Hydrazine sulphate (5 RCTs, n=796). Four of the 5 RCTs reported no significant difference in appetite or weight gain between oral hydrazine (60 to 180 mg/day) and placebo; the fifth RCT reported improved appetite and increased or maintained weight with hydrazine.
Studies of other drugs reported mixed results or positive results only in individual studies, or were not placebo-controlled.