Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
BACKGROUND: Undernutrition due to inadequate energy intake secondary to lack of appetite is not uncommon in children. Megesterol acetate (Megace®) is a synthetic progestin that has been used as an appetite stimulant to treat weight loss in adults with cancer and AIDS.
AIM: To evaluate the effect of megesterol acetate on weight gain and linear growth in children with growth failure.
SUBJECTS & METHODS: Retrospective evaluation of 36 children (12 girls) median age 2.7yr (range 8 mo to 10 yr) with growth failure, treated with megesterol acetate at Division of Gastroenterology/Nutrition at Texas Children's Hospital, Houston. Their diagnosis included failure to thrive 12, gastroesophageal reflux 11, former preterm babies 4, feeding disorder 3, allergic enteropathy 2, congenital heart disease 2. Weight, height, and weight:height ratio were documented from 6 mo before and after initiation of megesterol acetate therapy. Measurements were corrected for age and sex by conversion to z-score.
RESULTS: The median duration of therapy was 7 mo (range, 1 to 15 mo) and median megesterol acetate dose was 10 mg/kg/d (range 3.3 to 12 mg/kg/d). During megesterol acetate treatment, mean changes in weight z-score were +0.52 after 1 mo of therapy (P=0.003), +0.73 after 3 mo (P=0.6), +1.5 after 4 mo (P=0.01) and +2 after 7 mo (P=0.001). Megesterol acetate therapy was not associated with changes in linear growth. During megesterol acetate treatment, median changes in weight/Height z-score were +0.81 after 1 month of therapy (P=0.003), +1 after 3 months (P=0.06), +1.4 after 4 mo (P=0.01), and +0.91 after 6 months (P=0.1). Adverse effects were infrequent and minimal such as vaginal discharge, pruritus, irritability and sleeplessness, which resolved with reduction in the dose.
CONCLUSION: Megesterol acetate therapy is a powerful appetite stimulant which led to weight gain in children with undernutrition. Megesterol acetate is well tolerated, with few and mild side-effects.