Remeron Increases Energy Consumption in NSCLC and Anorexia

Using an antidepressant drug increases energy consumption but not appetite, research has shown.

For patients with advanced non-small cell lung cancer (NSCLC) and anorexia, the use of the antidepressant Remeron (mirtazpine) has been shown to increase energy consumption, but not appetite, according to recent study results.

Research published in JAMA Oncology from a clinical trial evaluating 86 adult patients with advanced NSCLC evenly randomized to receive 15 milligrams of Remeron or placebo for two weeks followed by a dose escalation to 30 milligrams or placebo until week 8, with both patient cohorts receiving nutritional assessments and daily advice and researchers reporting that there was no difference in appetite between the two patient groups.

“But the (Remeron) group had a significant increase in energy intake through the four- and eight-week follow-up, mainly in fat intake, which is a better and crucial source of energy,” researchers wrote in JAMA Oncology. “The addition of (Remeron) in the treatment of patients with advanced NSCLC and anorexia may help these patients achieve their energy requirements and improve health-related quality of life, specifically emotional and cognitive functioning.”

The fact that there is no current standard therapy addressing cancer-related anorexia, researchers noted, is “hampering survival.”

Further Research

The American Cancer Society classifies anorexia as a loss of appetite and explains that individuals with a low appetite lasting longer than a few days usually lose weight, resulting in weakness and fatigue that can affect quality of life, their ability to perform activities and their response to cancer treatments. Potential cancer-related causes of low or no appetite, they detail, can include hormones released by tumors, pain, stress, depression, dehydration, nausea, surgery and treatment-related side effects.

Sixty percent of surveyed patients with lung cancer and survivors in research published by the organization LUNGevity experienced weight loss, decreased appetite, loss of muscle mass/muscle wasting or malnutrition, while 41% of respondents had experienced more than one of those physical changes after receiving their diagnosis.

Patients with advanced NSCLC who meet weight-based criteria for cancer anorexia-cachexia syndrome (CACS) — which involves involuntary weight loss, anorexia, declining function, muscle catabolism and inflammation — were found to “have inferior survival compared to a similar population without weight loss,” according to study findings published in the Journal of Clinical Oncology.

The phase 1b/2a Cancer Appetite Recovery Study (CAReS Trial) is currently underway evaluating ART27.13, a once-daily dual cannabinoid receptor agonist medication intended to increase appetite and food intake and decrease muscle wasting, according to Artelo Biosciences, the pharmaceutical company behind the trial

Among the 86 patients in the JAMA Oncology study, Remeron was found to have “significantly increased energy intake” after four weeks of treatment — including proteins, carbohydrates and fats, with fat intake “significantly higher” among those receiving Remeron versus those on placebo (14.5 grams versus .7 grams) after eight weeks. Sarcopenia, or loss of muscle mass and strength, was likewise decreased on Remeron versus placebo after eight weeks (82.8% versus 57.1%).

Notably, patients treated with Remeron reported a higher perception of nightmares at two weeks than those treated with placebo, but the nightmare finding “was nonsignificant after four and eight weeks,” researchers noted.

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