Evaluation of the Use of Appetite Stimulants in Pediatric Patients with Cystic Fibrosis

Abstract

Objective: Poor nutrition in patients with cystic fibrosis (CF) has been associated with lower lung function and increased morbidity and mortality. Conversely, better nutritional status has been associated with improved pulmonary function and fewer CF-associated complications. There is no consensus regarding appetite stimulant therapy in patients with CF (pwCF). The primary objective of this study was to determine if the use of appetite stimulants was associated with weight changes in pediatric pwCF in the ambulatory care setting. Methods: This was a retrospective study that evaluated 62 pediatric pwCF who received cyproheptadine or mirtazapine for appetite stimulation for at least 6 consecutive months. Weight z-scores were collected for each patient at baseline, 3, 6, and 12 months of therapy, if available. Results: Increase in weight z-score after 3 months of therapy was statistically significant based on both univariable and multivariable models when evaluating the entire cohort. The adjusted mean difference for change in weight z-score was 0.33 (p< 0.001) from baseline to month 3. There was a statistically significant improvement in pulmonary function after 3 and 6 months of therapy. Conclusions: Appetite stimulant therapy is associated with improvement in weight z-score in the first 3 months of treatment. Appetite stimulant therapy was associated with improvement in pulmonary function in the first 3 months of therapy, which supports the relationship between weight gain and improved pulmonary function in pwCF. These findings suggest that appetite stimulants contribute to weight gain in pediatric pwCF, particularly within the first 3 months of therapy.

Evolving nutritional needs, obesity, and overweight status in cystic fibrosis

“…Among hospitalized children, undernutrition is more frequent in the CF population (45%) compared to children with other chronic conditions (30%) [15]. Intervention among malnourished CF children with appetite stimulants demonstrated both improvement in weight z-score as well as pulmonary function after three months of treatment [16]. Feeding by gastrostomy continues to be utilized as a tool to address malnutrition when present.…”

A novel compounded cyproheptadine hydrochloride oral solution: Accelerated stability study and effects on glucose and lipid metabolism in Wistar rats

“…Therefore, its antiserotoninergic effect can explain the increase in appetite and weight gain. This also justifies its interest as an appetite stimulant, especially in cases of cystic fibrosis [1,6,7]. This drug is also indicated for treatment of allergic conditions such as urticaria, angioedema, rhinitis, conjunctivitis, and pruritic skin disorders [8][9][10].…”