Efficacy of sertraline for palliative management of refractory breathlessness

Breathlessness continues to be a major clinical problem for many people with advanced progressive illnesses such as cancer, end-stage cardiac failure or chronic obstructive pulmonary disease even when they are receiving the best treatment for the underlying disease. Although there are some interventions that may offer benefit (oxygen therapy, sustained release low dose morphine), there is still a need for a wider range of interventions to meet the needs of people with refractory breathlessness. Sertraline, an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class, is primarily used to treat major depression as well as obsessive–compulsive, panic, and social anxiety disorders. Previous research has suggested that treatment of concomitant mood or anxiety symptoms can improve dyspnoea however studies are needed to further clarify its potential benefits for the treatment of breathlessness. The research team has conducted a Phase II double blind, titrated dose, multi-site placebo controlled pilot study of sertraline (ACTRN12608000253303) using the proposed inclusion and exclusion criteria and the measures proposed in this study design. The pilot study has demonstrated acceptability and feasibility of this study, however further Phase III data is needed in order to ensure that this is a well tolerated and effective intervention suitable for a broad range of people with refractory breathlessness. This study will evaluate critically a new but theoretically useful therapy whose role needs to be carefully defined. Although sertraline has been used in small uncontrolled studies, the evidence for a net clinical benefit is inadequate. Aim: The primary aim is to test the efficacy of sertraline compared with placebo in relieving the sensation of intractable breathlessness. Secondary aims focus on the impact of the sertraline on improving quality of life (QOL), dyspnoea-related anxiety and depression, adverse effects, function and clinical predictors of benefit.