It’s a Thing, that we tend to publish and read studies that show that new medications or interventions improve things, rather than that a possible treatment or intervention does not help. But both are important, right? If a treatment that is being given to people is shown to not work, we need to know about that too.
The prolific team at PaCCCS including Professors Currow and Agar have published a trial of sertraline (an antidepressant) in breathlessness and found it did not improve breathlessness scores compared with those taking a placebo tablet. Quality of life improved slightly in those taking the sertraline, however. Overall, they felt that sertraline did not provide benefit.
Their research question was: Does sertraline provide symptomatic relief for chronic breathlessness in people with advanced disease whose underlying cause(s) are optimally treated?
Two hundred and twenty three participants with chronic breathlessness (modified Medical Research Council (mMRC) breathlessness scale ≥2) who had optimal treatment of underlying cause(s) were randomised 1:1 to sertraline 25 mg–100 mg (titrated upwards over nine days) or placebo for four weeks. The primary outcome was the proportion who had an improvement in intensity of current breathlessness >15% from baseline on a 100 mm visual analogue scale (VAS).
The proportion of people responding to sertraline was similar to placebo for current breathlessness on days 26–28 (odds ratio [OR] 1·00, 95% CI 0.71–1·40) and for other measures of breathlessness. Quality of life in the sertraline arm had a higher likelihood of improving than placebo over the four weeks (OR 0·21, 95% CI 0·01–0·41, p=0·044). No differences in performance status, anxiety and depression, nor survival were observed. Adverse event rates were similar between arms.
Sertraline does not appear to provide any benefit over placebo in the symptomatic relief of chronic breathlessness in this patient population.