Antidepressants combat cancer-related appetite suppression

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More than half of patients with lung cancer develop anorexia, but mirtazapine can increase energy consumption and reduce sarcopenia, research shows.

Adding mirtazapine to the treatment plan significantly increased energy intake for lung cancer patients compared to placebo according to a study published in JAMA Oncology last month.  

The single-centre trial randomised 86 adults with advanced non-small cell lung cancer and anorexia to receive either placebo for eight weeks, or 15mg of mirtazapine daily for the first two weeks and then 30mg until week eight. 

The mirtazapine group had a significantly higher energy intake than the placebo group after four weeks (379 kcal vs 139 kcal) and at eight weeks (358 kcal vs 227 kcal). 

Appetite increased similarly in both the mirtazapine and placebo group at four and eight weeks, but only those in the treatment group achieved 100% of their intake requirements. 

The majority of the increased energy intake in the treatment group came from fat, which researchers said could be positive for lung cancer patients.  

“A high fat intake has been associated with significantly improved respirator function markers and respiratory quotients in patients with lung cancer,” they said.  

A secondary outcome of the study was that significantly fewer patients in the mirtazapine group had sarcopenia at eight weeks than in the placebo group.  

Sarcopenia at baseline was seen in 66% of participants overall at baseline. There were no significant differences in weight changes between the two groups but after eight weeks sarcopenia was identified in almost 83% of the placebo group and only 57% of the mirtazapine group. 

“Anthropometric changes were not detected within or between groups. Although body weight was not significantly changed in both groups after follow-up, mirtazapine significantly diminished the proportion of patients with sarcopenia and weight was stable at 8 weeks,” the authors noted. 

The mirtazapine group also experienced increased health-related quality of life and improvements in emotional and cognitive functioning. 

There was a 37% reduction in depression and anxiety for the mirtazapine group that was not seen in the placebo group. Perception of fatigue was also lower in the mirtazapine group than in the placebo group at eight weeks. 

“Mirtazapine had a positive effect in global health status, HADS score, and functional scales, especially cognitive functioning,” researchers concluded. 

Professor Brian Oliver, head of the Respiratory Cellular and Molecular Biology Group at the Woolcock Institute of Medical Research, told TMR mirtazapine had been known to improve appetite for a long time and this study may help prove effectiveness in this particular cohort of patients. 

Cancer-related weight loss and anorexia are common issues, said Professor Olver, with a third of lung cancer patients undergoing chemotherapy experiencing weight loss of more than 5% of their starting weight. 

Without energy from food consumption, the body copes differently with treatment, he explained.  

“Studies show that all outcomes are worse for patients with lung cancer who have weight loss, and patients who have weight gain during chemo have better clinical outcomes,” he said.  

JAMA Oncology, online January 11. 

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