Cachexia

Cachexia is a multifactorial wasting syndrome defined by involuntary loss of ≥5% body weight with muscle depletion, driven by systemic inflammation and metabolic dysregulation; it complicates cancer, HIV/AIDS, COPD, heart failure, and chronic kidney disease. Dronabinol (Marinol) received FDA approval in 1992 for anorexia associated with weight loss in patients with AIDS, based on small trials showing modest appetite and weight stabilization. NASEM (2017) rated the evidence as limited that cannabis or cannabinoids are effective for increasing appetite and decreasing weight loss in HIV/AIDS. Evidence in cancer cachexia is weaker: the pivotal Cannabis-In-Cachexia-Study-Group trial (Strasser et al., J Clin Oncol 2006) randomized 243 patients to cannabis extract, THC, or placebo and was terminated early for futility, with no difference in appetite or quality of life ⚠️. NASEM categorized cancer-cachexia evidence as insufficient. → See also: Dronabinol, Anorexia, THC, CB1 receptor.