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Glukokortikoide und Androgene zur Behandlung von Müdigkeit und Schwäche bei Palliativpatienten

Eine systematische Übersichtsarbeit

Glucocorticoids and androgens for treatment of tiredness and weakness in palliative care patients

A systematic review

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Zusammenfassung

Hintergrund

Die Therapie von Müdigkeit, Schwäche und Fatigue in der Palliativversorgung wird zunehmend wichtiger. Glukokortikoide und Androgene werden als Behandlungsoption genannt. In dieser Literaturübersicht wird die vorliegende Evidenz für deren Einsatz dargestellt.

Material und Methoden

Die Literaturdatenbanken PubMed und Embase wurden bis August 2011 in einer systematischen Suche nach Studien zum Einsatz von Glukokortikoiden und Androgenen bei Fatigue, Asthenie, Sedierung, Müdigkeit, Schwäche, Erschöpfung, Kachexie und Wasting in der Palliativversorgung durchsucht. Zusätzlich wurden die Cochrane Library, Literaturangaben relevanter Veröffentlichung und führende Lehrbücher durchsucht. Studienangaben wurden auf ein standardisiertes Formblatt extrahiert. In einer Kategorisierung der Studien wurden 5 Endpunkte abgegrenzt: Fatigue, Kraft/Schwäche/Stärke, Müdigkeit, Wohlbefinden/Lebensqualität, Energie/Aktivität/Leistungsfähigkeit.

Ergebnisse

Insgesamt wurden 11 kontrollierte Glukokortikoid- und 13 kontrollierte Androgenstudien eingeschlossen. Zusätzlich ausgewertet wurden 4 unkontrollierte Studien, 2 Fallserien und 2 Umfragen bei den Glukokortikoiden und 6 unkontrollierte Studien und 1 Fallserie bei den Androgenen. Alle kontrollierten Glukokortikoidstudien wurden bei Tumorpatienten durchgeführt und alle bis auf eine kontrollierte Androgenstudie an HIV-positiven Teilnehmern. Glukokortikoidgaben führten zu einer verbesserten Lebensqualität. Die Aussagen zur Veränderung von Fatigue und Schwäche waren widersprüchlich. Müdigkeit und Energie wurden nicht verbessert. Androgene hatten einen positiven Effekt auf Fatigue und Lebensqualität. Schwächeveränderungen waren unterschiedlich und Energieverbesserungen wurden in den meisten Fällen nicht festgestellt. Nebenwirkungen wurden regelmäßig beobachtet, führten jedoch nur selten zu Therapieabbrüchen.

Schlussfolgerung

Der Einsatz von Glukokortikoiden und Androgenen zur Verbesserung von Müdigkeit und Schwäche in der Palliativversorgung kann nicht generell empfohlen werden. In einem individuellen Therapieversuch können Glukokortikoide bei Tumorpatienten und Androgene bei HIV-positiven Patienten zur Verbesserung der Lebensqualität angewendet werden. Der Einsatz bei Patienten mit anderen Grunderkrankungen sollte in kontrollierten Studien mit einem einheitlichen Setting überprüft werden.

Abstract

Background

The therapy of tiredness, weakness and fatigue in palliative care patients is of growing interest. Glucocorticoids and androgens are habitually mentioned drugs for treatment. In this review evidence for glucocorticoids and androgens for these indications in palliative care patients are presented.

Materials and methods

A systematic search of PubMed and Embase for studies on glucocorticoids and androgens for fatigue, asthenia, sedation, tiredness, weakness, exhaustion, cachexia, drowsiness and wasting in palliative care was carried out in August 2011. Furthermore, the Cochrane Library, references from the literature and leading textbooks were also searched. Study information was entered in a standardized extraction sheet. By a categorization of studies five endpoints were distinguished: fatigue, strength/weakness, tiredness, well being/quality of life and energy/activity/performance.

Results

A total of 11 controlled studies with glucocorticoids and 13 controlled studies with androgens were included. In addition four uncontrolled studies, two case series and two surveys with glucocorticoids as well as six uncontrolled studies and one case series with androgen treatment were analyzed. All controlled trials of glucocorticoids were performed in cancer patients and all but one controlled trial of androgens in patients with HIV/AIDS. Glucocorticoids improved quality of life but results for changes of fatigue and weakness were inconsistent. Tiredness and energy were not improved. Androgens had a positive effect on fatigue and quality of life and showed variable effects on weakness. Androgens did not improve energy. Side effects were frequently documented but only rarely resulted in discontinuation of therapy.

Conclusion

With the existing evidence no general recommendation for glucocorticoid and androgen use in tiredness and weakness in palliative care patients can be given; however, glucocorticoids in cancer patients and androgens in HIV positive-patients can be used in an individual trial for improving patient quality of life. The use in patients suffering from other disease entities should be evaluated in randomized controlled trials with a similar setting. The English full text version of this article will be available in SpringerLink as of November 2012 (under “Supplemental”).

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Danksagung

Die Arbeit wurde nach den Vorgaben der Steuerungsgruppe der Therapieempfehlungen Palliativmedizin der Arzneimittelkommission der deutschen Ärzteschaft (Lukas Radbruch, Friedemann Nauck, Bernd Alt-Epping, Roman Rolke, Mariam Ujeyl, Rainer Lasek) und ohne externe Förderung durchgeführt.

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  1. Klinik für Palliativmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    A. Thiem, R. Rolke &  L. Radbruch

  2. Lehrstuhl für Palliativmedizin, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland

    L. Radbruch

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  1. A. Thiem
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Thiem, A., Rolke, R. & Radbruch, L. Glukokortikoide und Androgene zur Behandlung von Müdigkeit und Schwäche bei Palliativpatienten. Schmerz 26, 550–567 (2012). https://doi.org/10.1007/s00482-012-1214-9

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