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Communications to the Editor |

Megestrol Complications FREE TO VIEW

Richard G. Bennett, MD
Author and Funding Information

Affiliations: Johns Hopkins Geriatrics Center Baltimore, MD,  Langhorne, PA

Correspondence to: Richard G. Bennett, MD, Division of Geriatric Medicine and Gerontology, Johns Hopkins Geriatrics Center, 5505 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail: rbennett@jhmi.edu



Chest. 2003;123(1):309-310. doi:10.1378/chest.123.1.309
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To the Editor:

I am writing following the publication of a recent article in CHEST,1 which reported that megestrol acetate safely increases appetite and body weight among underweight COPD patients.

In that report, the authors did not report any complication from megestrol acetate therapy, and this result is very different from our experience in a local nursing home, reported in the Journal of the American Medical Directors Association.2In our study, the incidence of deep vein thrombosis among 19 patients treated with megestrol acetate was 87,952 cases per 100,000 patient-years. This rate is appreciably higher than reported rates among older adults (300 to 800 cases per 100,000 patient-years).35

Concluding that megestrol acetate treatment for appetite stimulation is safe based upon a randomized study of 145 patients treated for only 8 weeks seems premature. Until larger, randomized, prospective, controlled trials of megestrol acetate treatment vs no other treatment for patients at-risk nutritionally are conducted, clinicians should proceed cautiously in using this drug. If megestrol acetate is prescribed, examination for deep vein thrombosis should be done regularly, and a high index of suspicion for this complication should be maintained.

Weisberg, J, Wanger, J, Olson, J, et al (2002) Megestrol acetate stimulates weight gain and ventilation in underweight COPD patients.Chest121,1070-1078. [PubMed] [CrossRef]
 
Bolen, JC, Andersen, RE, Bennett, RG Deep vein thrombosis as a complication of megestrol acetate therapy among nursing home residents.J Am Med Dir Assoc2000;48,248-252
 
Hansson, PO, Welin, L, Tibblin, G, et al Deep vein thrombosis and pulmonary embolism in the general population.Arch Intern Med1997;157,1665-1670. [PubMed]
 
Kniffin, WD, Baron, JA, Barrett, J, et al The epidemiology of diagnosed pulmonary embolism and deep vein thrombosis in the elderly.Arch Intern Med1994;154,861-866. [PubMed]
 
Nordstrom, M, Linblad, B, Bergqvist, D, et al A prospective study of the incidence of deep vein thrombosis within a defined urban population.J Intern Med1992;232,155-160. [PubMed]
 
To the Editor:

Dr. Bennett’s letter warned of the risk of deep venous thrombosis (DVT) as a complication of treatment with megestrol acetate among nursing home patients. We agree that DVT is an established risk of this treatment, but we believe there are good reasons why our experience1 is different than the one he previously reported.

We would like to point out that Bennett’s observation2 was retrospective and without a randomized control group, and that only 18 patients were at risk (patients who received megestrol acetate over a specific 9-month period at a nursing home). Although DVT developed in six patients, two patients were at especially high risk since one patient had endometrial cancer and another patient had a recent fracture. Because the study was initiated when a cluster of DVT episodes were observed, we believe that projecting incidence in the nursing home population is questionable. Also, reporting DVT incidence per 100,000 patient-years is misleading when the summed observation period for all patients receiving megestrol acetate was approximately 7 years.

Furthermore, of the at-risk patients, one was not ambulatory, three had presence of arrhythmia, two had suffered stroke, and three had coronary artery disease. The average age of the patients with DVT was 80 years.

Moreover, Dr. Bennett’s study is in apparent conflict with that of Yeh et al,3 who specifically studied nursing home patients for weight and quality-of-life measures. None of the 36 patients treated with megestrol acetate in their study acquired DVT.

The average age of our patients was 67 years, and all were ambulatory. Our intervention was limited to 56 days; most of Dr. Bennett’s nursing home residents experienced DVT after > 50 days of treatment.

Although Dr. Bennett’s article is thought provoking, it hardly refutes the safety findings of our study, where no patient was reported to have DVT in our randomized, prospective, and much larger patient population (72 receiving megestrol acetate and 73 receiving placebo).

Based on our study, we believe the benefits of short-term administration of megestrol acetate in underweight patients with COPD might outweigh the risks. We believe that future trials will prove that megestrol acetate can be an important component in the management of the underweight COPD patient.

References
Weisberg, J, Wanger, J, Olson, J, et al Megestrol acetate stimulates weight gain and ventilation in underweight COPD patients.Chest2002;121,1070-1078. [PubMed] [CrossRef]
 
Bolen, J, Andersen, R, Bennett, R Deep vein thrombosis as a complication of megestrol acetate therapy among nursing home residents.J Am Med Dir Assoc2000;48,248-252
 
Yeh, S-S, Wu, S-Y, Lee, T-P, et al Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of double-blind placebo-controlled study.J Am Geriatr Soc2000;48,485-492. [PubMed]
 

Figures

Tables

References

Weisberg, J, Wanger, J, Olson, J, et al (2002) Megestrol acetate stimulates weight gain and ventilation in underweight COPD patients.Chest121,1070-1078. [PubMed] [CrossRef]
 
Bolen, JC, Andersen, RE, Bennett, RG Deep vein thrombosis as a complication of megestrol acetate therapy among nursing home residents.J Am Med Dir Assoc2000;48,248-252
 
Hansson, PO, Welin, L, Tibblin, G, et al Deep vein thrombosis and pulmonary embolism in the general population.Arch Intern Med1997;157,1665-1670. [PubMed]
 
Kniffin, WD, Baron, JA, Barrett, J, et al The epidemiology of diagnosed pulmonary embolism and deep vein thrombosis in the elderly.Arch Intern Med1994;154,861-866. [PubMed]
 
Nordstrom, M, Linblad, B, Bergqvist, D, et al A prospective study of the incidence of deep vein thrombosis within a defined urban population.J Intern Med1992;232,155-160. [PubMed]
 
Weisberg, J, Wanger, J, Olson, J, et al Megestrol acetate stimulates weight gain and ventilation in underweight COPD patients.Chest2002;121,1070-1078. [PubMed] [CrossRef]
 
Bolen, J, Andersen, R, Bennett, R Deep vein thrombosis as a complication of megestrol acetate therapy among nursing home residents.J Am Med Dir Assoc2000;48,248-252
 
Yeh, S-S, Wu, S-Y, Lee, T-P, et al Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of double-blind placebo-controlled study.J Am Geriatr Soc2000;48,485-492. [PubMed]
 
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