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

David C. Currow, Magnus Ekstrӧm, Sandra Louw, Julie Hill, Belinda Fazekas, Katherine Clark, Patricia M. Davidson, Christine McDonald, Dimitar Sajkov, Nikki McCaffrey, Matthew Doogue, Amy P. Abernethy, Meera Agar
European Respiratory Journal 2018; DOI: 10.1183/13993003.01270-2018
David C. Currow
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
2Discipline of Palliative and Supportive Services, Flinders University, South Australia, Australia
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Magnus Ekstrӧm
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
3Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden
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Sandra Louw
4McCloud Consulting Group, Narabang Way, Belrose, New South Wales, Australia
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Julie Hill
4McCloud Consulting Group, Narabang Way, Belrose, New South Wales, Australia
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Belinda Fazekas
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
2Discipline of Palliative and Supportive Services, Flinders University, South Australia, Australia
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Katherine Clark
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
5University of Sydney, Northern Clinical School, Royal North Shore Hospital, St Leonard's, New South Wales
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Patricia M. Davidson
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
6School of Nursing, Johns Hopkins University, Baltimore, United States of America
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Christine McDonald
7Austin Health, Heidelberg, Victoria, Australia
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Dimitar Sajkov
8Flinders Medical Centre, Department of Respiratory & Sleep Medicine, Medical Centre Drive, Bedford Park, South Australia, Australia
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Nikki McCaffrey
9Deakin Health Economics, School of Health and Social Development, Deakin University, Victoria, Australia
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Matthew Doogue
10University of Otago, Christchurch, New Zealand
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Amy P. Abernethy
2Discipline of Palliative and Supportive Services, Flinders University, South Australia, Australia
11Duke University, Carey, North Carolina, United States of America
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Meera Agar
1IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Abstract

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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Currow has nothing to disclose.

Conflict of interest: Ms. Louw reports personal fees from Palliative Care Clinical Studies Collaborative, during the conduct of the study.

Conflict of interest: Dr. Hill has nothing to disclose.

Conflict of interest: Dr. Fazekas has nothing to disclose.

Conflict of interest: Dr. Clark has nothing to disclose.

Conflict of interest: Dr. Davidson has nothing to disclose.

Conflict of interest: Dr. Sajkov has nothing to disclose.

Conflict of interest: Dr. McCaffrey has nothing to disclose.

Conflict of interest: Dr. Doogue has nothing to disclose.

Conflict of interest: Dr. Abernethy has nothing to disclose.

Conflict of interest: Dr. Agar has nothing to disclose.

Conflict of interest: Dr. Ekström has nothing to disclose.

Conflict of interest: Dr. McDonald reports personal fees from GSK, personal fees from Pfizer, other from Menarini, personal fees from Novartis, outside the submitted work.

This is a PDF-only article. Please click on the PDF link above to read it.

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Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial
David C. Currow, Magnus Ekstrӧm, Sandra Louw, Julie Hill, Belinda Fazekas, Katherine Clark, Patricia M. Davidson, Christine McDonald, Dimitar Sajkov, Nikki McCaffrey, Matthew Doogue, Amy P. Abernethy, Meera Agar
European Respiratory Journal Jan 2018, 1801270; DOI: 10.1183/13993003.01270-2018

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Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial
David C. Currow, Magnus Ekstrӧm, Sandra Louw, Julie Hill, Belinda Fazekas, Katherine Clark, Patricia M. Davidson, Christine McDonald, Dimitar Sajkov, Nikki McCaffrey, Matthew Doogue, Amy P. Abernethy, Meera Agar
European Respiratory Journal Jan 2018, 1801270; DOI: 10.1183/13993003.01270-2018
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