Clinical remission of membranous glomerulonephritis in primary biliary cirrhosis with cutaneous vasculitis.
Authors: D J Reitsma, S Gratama, T M Vroom
Journal: BMJ (1984)

Prednisolone as an appetite stimulant in patients with cancer Anorexia is a common complaint of patients with cancer at all stages of their disease,1 and a random survey of 110 patients attending the department of clinical oncology at Gartnavel General Hospital showed it to be present in 43% of cases.Although no controlled trials have been performed,3 steroids have been used empirically for many years to promote wellbeing and stimulate appetite in patients with cancer.The aim of this study was to examine the effectiveness of prednisolone compared with placebo in stimulating appetite and in- creasing body weight, energy intake, and general wellbeing in a group of patients with cancer. Patients, methods, and resultsWe studied 61 patients complaining of poor appetite or weight loss and with no contraindication to steroids.The study was conducted as a double blind crossover trial, fixed dosages being used to simplify treatment.Patients were given prednisolone, 5 mg thrice daily for two weeks and then for a third week when the dosage was reduced; and placebo, one tablet thrice daily for two weeks and then for a further week when the dosage was reduced.The order of treatment was randomised.Assessment was carried out after two and five weeks of treatment, at the same time of day on each occasion.These timings coincided with patients' outpatient appointments.At each visit weight was recorded and a 24 hour dietary recall history was noted, which was analysed by computer using a program devised by Tayside health centre that gave the protein, carbohydrate, fat, and energy contents of the diet.Each patient completed a questionnaire and visual analogue scales assessing appetite, nausea, vomiting, mood, and wellbeing and reported any side cffects of treatment.Forty one of the 61 patients could be evaluated (16 men and 25 women, age range 27-80 (mean 60) years).They had various solid tumours, gastro- intestinal tumours being most common.All types of tumour showed a similar pattern of response to treatment.Twenty three patients were not receiving any chemotherapy during the study; 18 patients received a variety of different combination chemotherapies, which were timed to coincide with the study.None of the patients had had recent surgery and none had hypercalcaemia.Of the 20 patients who were excluded from the study, nine were randomised to take prednisolone first and 11 placebo first.Six patients died and three were admitted to hospital during the study; four patients started chemotherapy during the study and so could not be evaluated.Seven patients stopped taking their tablets during the study and were excluded.In most of these patients appetite continued to deteriorate or remained at pretreatment levels.No side effects were reported by any of the patients.Response rates in the groups receiving and not receiving chemotherapy reflected the results obtained in the entire group of patients.The x2 test was applied to the proportions of patients who responded.The table shows the results.Results in 41 patients (figures are numbers (%) ofpatients)