Ghrelin administration for chronic respiratory failure: a randomized dose-comparison trial

Area of Science:

• Pulmonary Medicine
• Endocrinology
• Nutritional Science

Background:

• Cachexia significantly impacts symptoms, muscle wasting, and exercise tolerance in pulmonary disease patients.
• Ghrelin administration has shown promise in improving these conditions.
• Optimal dosing for underweight chronic respiratory failure patients remains to be determined.

Purpose of the Study:

• To investigate the optimal ghrelin dose for underweight patients suffering from chronic respiratory failure.
• To compare the efficacy of 1 μg/kg versus 2 μg/kg of ghrelin administered twice daily.

Main Methods:

• A multicenter, randomized, dose-comparison study involving 44 cachectic patients with chronic respiratory failure.
• Patients received pulmonary rehabilitation with either 1 μg/kg or 2 μg/kg of ghrelin intravenously twice daily for 3 weeks.
• Primary endpoint: improvement in 6-minute walking distance (6 MWD); Secondary endpoint: change in peak oxygen uptake (VO2).

Main Results:

• Both 1 μg/kg and 2 μg/kg ghrelin groups showed similar improvements in 6 MWD.
• The 2 μg/kg group demonstrated a significantly greater improvement in peak VO2 compared to the 1 μg/kg group.
• The 2 μg/kg group also showed remarkable improvements in food intake, lean body mass, St. George Respiratory Questionnaire score, body weight, and body mass index.

Conclusions:

• Twice-daily administration of 2 μg/kg ghrelin for 3 weeks resulted in greater improvements in oxygen uptake capacity than 1 μg/kg.
• While exercise tolerance was similar, the higher ghrelin dose is recommended for chronic respiratory failure patients with weight loss.
• No serious treatment-related adverse events were reported, indicating a favorable safety profile.