Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial

Area of Science:

• Palliative Care
• Clinical Pharmacology
• Respiratory Medicine

Background:

• Chronic breathlessness is a debilitating symptom in advanced diseases.
• Optimal treatment of underlying causes is crucial but may not fully alleviate breathlessness.
• Selective serotonin reuptake inhibitors (SSRIs) are being explored for non-psychiatric symptoms.

Purpose of the Study:

• To investigate the efficacy of sertraline in providing symptomatic relief for chronic breathlessness.
• To assess the impact of sertraline on quality of life, performance status, anxiety, and depression in patients with advanced disease.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving 223 participants with chronic breathlessness (modified Medical Research Council breathlessness scale ≥2).
• Participants received either sertraline (25-100 mg, titrated over 9 days) or placebo for 4 weeks.
• Primary outcome: proportion with >15% improvement in current breathlessness intensity (100-mm visual analogue scale) at days 26-28.

Main Results:

• Sertraline showed no significant difference from placebo in improving current breathlessness intensity (OR 1.00, 95% CI 0.71-1.40).
• Quality of life demonstrated a higher likelihood of improvement in the sertraline arm (OR 0.21, 95% CI 0.01-0.41; p=0.044).
• No differences were observed in performance status, anxiety, depression, or survival; adverse event rates were similar between groups.

Conclusions:

• Sertraline does not appear to offer symptomatic relief for chronic breathlessness in patients with advanced disease when underlying causes are optimally treated.
• While a potential benefit in quality of life warrants further investigation, sertraline is not recommended for breathlessness symptom management in this population.