悪液質に対する薬物療法レビュー

悪液質に対する薬物療法のレビュー論文を紹介します。

Elamin E. Dietary and Pharmacological Management of Severe Catabolic Conditions. Am J Med Sci. 2011 Jun 24. [Epub ahead of print]

以前は悪液質に対してプロゲステロンかステロイド程度しかありませんでしたが、現在ではその他に抗セロトニン薬、BCAA、EPA、メラノコルチン拮抗薬、抗ミオスタチン薬といった選択肢も出てきています。図を参照してください。

臨床現場で実際に使用できるのは、BCAAとEPA程度ですが、悪液質に対して必ず有効とは言えませんが、これらは試してみてよいのではないかと私は感じています。

Abstract
INTRODUCTION: Nutritional debilitation is among the most devastating and life-threatening complications of cancers and various chronic diseases. It arises from a complex interaction between the illness and the host. This process includes cytokine production, release of lipid-mobilizing and proteolysis-inducing agents and alterations in intermediary metabolism. As a result, many patients develop cachexia with progressive body fat and muscle tissue wasting with associated worsening of their clinical status and a lower quality of life. This review will provide up-to-date information about different pharmacological management of cachexia.

FINDINGS: Until recently, the 2 major options for pharmacological therapy have been either progestational agents or corticosteroids. However, knowledge of the mechanisms of cachexia has led to newer therapeutic interventions for treating several aspects of the syndrome. These include antiserotonergic agents, branched-chain amino acids, eicosapentanoic acid, melanocortin antagonists and antimyostatin agents-all of which act on the feeding-regulatory circuitry to increase appetite and inhibit illness-derived catabolic elements.

CONCLUSIONS: Information from this review will guide health care providers in limiting weight loss and improve performance status of the cachectic patients through dietary and pharmacological therapy, with the hope that such approach would extend patients survival and improve their quality of life.