By Sarah Guy
The drug methylphenidate is well tolerated among advanced cancer patients and shows promise in alleviating depression in this group, report researchers from Spain.
In a randomized, placebo-controlled study, 45% of terminally ill cancer patients who took methylphenidate for at least one dose reported a relief in depressive symptoms, compared with 26% of patients who took placebo.
The researchers defined such a response as a reduction of at least two points on the Edmonton Symptom Assessment Scale (ESAS).
While the difference in response was not statistically significant, the findings indicate clinically useful benefits of methylphenidate that require confirmation in a large carefully conducted trial, say Alvaro Sanz (Hospital Universitario del Rio Hortega, Valladolid, Spain) and co-investigators.
As published in BMJ Supportive and Palliative Care, the authors explain that once depressive symptoms are presented in a terminally ill cancer patient, palliation becomes an "urgent objective."
They add that, in contrast with classic antidepressants that have an effect delay, psychostimulant drugs such as methylphenidate are an appropriate option because they start to take effect within hours of being taken.
Sanz and team recruited 69 patients to their study whose cancer had no option for radical treatment. All patients scored at least two points on the Two Question Screening Survey, indicating they had been feeling low, depressed, or despondent, or had felt a lack of interest or satisfaction over the previous month.
A total of 69 patients took part in the study - 31 were randomly assigned to receive daily methylphenidate at one of five dosing levels between 10 mg and 45 mg, and 38 were assigned to matched doses of placebo.
The researchers report a trend toward an improvement in depression symptoms among the methylphenidate-treated patients, although differences in ESAS scores and Hospital Anxiety and Depression Scale evaluations were not statistically significant.
However, the between-group difference in reported adverse events was also nonsignificant (both=71%) and all of the side effects presented in less than 10% of patients, remark the authors.
The team acknowledges that the power of the study (recruitment of just 69 patients as opposed to the expected 98) limits the detection of meaningful results, but suggests that it could be interpreted as a pilot study for future trials.
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