Use of corticosteroids for anorexia in palliative medicine: a systematic review.

Abstract

Anorexia is a significant problem in patients approaching the end of life, for which corticosteroids are widely prescribed. It is not clear which regimen is the most safe and effective for this indication. The study objective was to identify the evidence for the use of corticosteroids, and the most safe and effective dosing regimen for management of anorexia in palliative care patients. A search of MEDLINE and CINAHL was carried out to identify original studies relevant to this question. These were reviewed against inclusion criteria and articles for inclusion were identified. Data was extracted and a narrative analysis was carried out. Subjects were adult patients with life-limiting diagnoses prescribed corticosteroids for anorexia in any care setting. Quality of studies was assessed using the system used by the Scottish Intercollegiate Guidelines Network for grading evidence. Eight articles were identified that met the inclusion criteria. The corticosteroid drugs and dosing regimens used were wide ranging, and a variety of tools were used to assess appetite within these studies. All studies showed improvement in appetite with the corticosteroid used, although this did not always reach statistical significance. It was not possible to identify the most effective corticosteroid drug, dose, or duration of treatment from the identified studies: the best quality evidence was for an eight-week course of intravenous methylprednisolone; however the studies using this regimen had the highest attrition rates. Corticosteroids are beneficial in treating anorexia in palliative care patients with malignancies; however there is no evidence for their use in anorexia due to end-stage nonmalignant disease. There is insufficient evidence to recommend any particular corticosteroid drug over another, or to recommend a dosing regimen.