ONS PEP Evidence Summary For Hot Flashes

For Use as an Intervention For Hot Flashes

  • Benefits Balanced With Harm

    Author and Year

    Kelly, C., Juurlink, D., Gomes, T., Duong-Hua, M., Pritchard, K., Austin, P., & Paszat, L. (2010). Selective serotonin reuptake inhibitors and breast cancer mortality in women. BMJ, 340, c693.

     doi:10.1136/bmj.c693

    Study Purpose:

    Researchers sought to show that  some SSRI antidepressants reduce tamoxifen’s effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6).

    Intervention Characteristics/Basic Study Process:

    The study enrolled postmenopausal women with breast cancer using tamoxifen therapy and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine.)

    Sample Characteristics:

    The study included women living in Ontariowho were 66 years or olderand treated with tamoxifen for breast cancer between 1993 and 2005 and with a single SSRI. (24,430 women were identified; 2,430 entered into study; mean age was 74 years).

    Inclusion criteria: Postmenopausal women with breast cancer newly treated with tamoxifen (defined as no tamoxifen prescription in the preceding year) and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine)

    Exclusion criteria: Antidepressant use of duloxetine or escitalopram

    Setting:

    Ontario Cancer Registry provided the data.

    Study Design:

    This was a retrospective cohort study.

    Measurement Instruments/Methods:

    The study examines the total duration of tamoxifen therapy (index date: date tamoxifen was last dispensed plus an additional 60 days) and the extent to which co-prescription of potentially interacting medications occurred during the course of treatment. The primary outcome was death from breast cancer

    Results:

    Of 2,430 women treated with tamoxifen and single SSRI, 374 (15%) died of breast cancer during follow up. Absolute increases of 25%, 50%, and 75% in the proportion of time on tamoxifen overlappingthe  use of paroxetine were associated with 24%, 54%, & 91% increases in the risk of death from breast cancer. (p < 0.05) No such risk was seen with other antidepressants

    Limitations:

    Reported study limitations included lack of information on breast cancer stage and lack of information on indication for antidepressant use.