Colby Stong
Patients with asthma with increased exacerbations and comorbid major depressive disorder (MDD) achieved improved asthma control using citalopram and escitalopram, according to a study in the Annals of Allergy, Asthma & Immunology.
Investigators pooled data from 3 randomized, double-blind, placebo-controlled, parallel-group 12-week trials to evaluate the efficacy of citalopram or escitalopram for patients diagnosed with asthma and MDD.
For all 3 studies, participants were English- or Spanish-speaking men and women at least 18 years of age with a diagnosis of asthma and depression. They were randomly assigned 1:1 to either citalopram/escitalopram or placebo; initial doses were 20 mg/day of citalopram or 10 mg/day of escitalopram.
Participants were tasked to complete the Asthma Control Questionnaire (ACQ) and the 17-item Hamilton Rating Scale for Depression (HAM-D17), which assessed depressive symptoms. Participants were also asked about corticosteroid use.
he pooled population included 255 patients (average [SD] age, 43.24 [11.30] years; 51% men). Of those, 49% identified as “African American” and the remainder were described as “non-African American.” Participants’ average baseline ACQ score was 2.41 (1.11), and their average HAM-D17 score was 25.16 (4.97). The treatment group (citalopram or escitalopram) included 128 participants and the placebo group included 127 participants. Among the cohort, 96 participants reported having at least 3 prednisone bursts in the previous 12 months and comprised a high exacerbation subgroup.
In the first analysis, statistically significant main effects were observed for baseline ACQ score, visit, study (P <.001 for all 3), sex (P =.018), and race (P =.005).
In the second fixed effects analysis with HAM-D17 as the outcome, treatment group was a significant predictor (P <.001). HAM-D17 scores in the treatment group were about 1.4 points lower compared with those in the placebo group, on average. Baseline HAM-D17 score also was significant (P <.001).
A binary logistic regression was conducted for corticosteroid use (yes/no), and overall results were significant (P <.01). The main effect of the treatment group was significant (P <.01), with patients in the treatment group having a reduced likelihood of corticosteroid use of about 41% vs the placebo group (odds ratio=0.591).
In the high exacerbation subgroup analyses, findings from the first fixed effects analysis with ACQ as the outcome showed statistically significant main effects for the treatment group (P =.004). In the fixed effects analysis with HAM-D17 as the outcome, significant main effects were observed for the treatment group (P <.001). Results from the binary (ie, yes/no) logistic regression with corticosteroid use as the outcome also were significant (P <.001), with significant main effects for the treatment group (P =.003).
Among several limitations, all 3 studies were conducted by the same research group, and all participants were recruited from the Dallas-Fort Worth area. In addition, the methods and inclusion/exclusion criteria differed among the studies.
“[I]n this pooled analysis, both depressive symptoms and asthma control appeared to improve after treatment with either citalopram or escitalopram,” the study authors stated. “Future work should include a randomized, double-blind, placebo-controlled, parallel-group trial with participants diagnosed with asthma but not a comorbid mood disorder to determine if the efficacy of selective serotonin reuptake inhibitors in increasing asthma control is mediated by improving depression symptoms,” the investigators added.
References: Agarwal CD, Palka JM, Gajewski AJ, Khan DA, Brown ES. The efficacy of citalopram or escitalopram in patients with asthma and major depressive disorder. Ann Allergy Asthma Immunol. Published online November 10, 2023. doi:10.1016/j.anai.2023.11.004