What is the evidence for mirtazapine in treating cancer-related symptomatology? A systematic review.
PURPOSE
Cancer patients often experience multiple distressing symptoms which are challenging to manage. It would therefore be helpful to find a treatment that alleviates more than one symptom, to avoid polypharmacy: mirtazapine has been used in several studies for this purpose. The objective of this study was to assess the effectiveness and safety of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms.


METHODS
Systematic review of clinical trials in English or French. Eight databases were searched. Included studies assessed the effectiveness of mirtazapine in alleviating one or more frequently encountered cancer-related symptoms. Comparator and validated assessment tools were required. Studies were independently appraised by two investigators before data synthesis.


RESULTS
The search yielded 1898 references, from which we identified 12 relevant articles evaluating highly heterogeneous outcomes. These were two randomised-controlled (RCTs), three non-randomised controlled, and seven non-randomised non-controlled trials. In total, 392 participants were included and 185 were in RCTs. No study assessed the effectiveness of mirtazapine in alleviating symptoms at the same time, but some considered more than one symptom. Overall, the data was of poor quality, limited by small sample size and bias. However, mirtazapine showed effectiveness in treating depression, anxiety, sleep disorders, emesis and neuropathic pain. Across all studies, mirtazapine is safe to use, with drowsiness and dizziness the most common side-effects.


CONCLUSION
Study design and small sample sizes limit the ability to interpret results. Trials to assess the impact of mirtazapine or other medicines in alleviating multiple symptoms would be valuable.
['Economos|Guillaume|G|https://orcid.org/0000-0003-1743-1280', 'Lovell|Natasha|N|https://orcid.org/0000-0001-6594-799X', 'Johnston|Anna|A|', 'Higginson|Irene J|IJ|https://orcid.org/0000-0002-3687-1313']
D058669:Adrenergic alpha-2 Receptor Antagonists D000928:Antidepressive Agents D002986:Clinical Trials as Topic D003863:Depression D006801:Humans D000078785:Mirtazapine D009369:Neoplasms D010166:Palliative Care D016032:Randomized Controlled Trials as Topic
Mirtazapine Neoplasms Palliative care Polysymptomatology Supportive care in cancer