Exploring vortioxetine combination with intranasal esketamine: A feasible alternative to SSRI/SNRI? - Insights from the REAL-ESK study.
Giacomo d'Andrea, Andrea Miuli, Mauro Pettorruso, Clara Cavallotto, Carlotta Marrangone, Alessio Cocco, Sergio De Filippis, Vassillis Martiadis, Ileana Andriola, Stefano Barlati, Antonio Vita, Bernardo Maria Dell'Osso, Stefano L. Sensi, Giorgio Di Lorenzo, Giovanni Martinotti
Journal of Affective Disorders December 15, 2024 DOI: 10.1016/j.jad.2024.09.004 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Post-hoc analysis Randomized Peer reviewed |
|---|---|
| Sample size | 20 |
| Population | TRD patients |
| Interventions | Vortioxetine Esketamine nasal spray |
| Duration | 3 months |
| Topics | Depression Esketamine |
| Keywords | Esk-ns Emotional blunting Glutamate Vortioxetine Depression treatment Treatment-resistant depression trd Antidepressants Mental health therapies Drug combinations |
| Citations | 6 |
| Key points | Vortioxetine plus ESK-NS was as effective as SSRI/SNRI plus ESK-NS in reducing depressive symptoms and showed a higher effect size in reducing emotional blunting at three months, with a better safety and tolerability profile. |
Abstract
Treatment-Resistant Depression (TRD) affects almost 30 % of patients with Major Depressive Disorder (MDD). Esketamine Nasal Spray (ESK-NS) has recently been approved for TRD in combination with a Serotonin Specific Reuptake Inhibitor/SSRI or a Serotonin-Norepinephrine Reuptake Inhibitor/SNRI. There is a lack of studies investigating the effectiveness and safety of ESK-NS in combination with other oral antidepressants. To assess the efficacy of Vortioxetine plus ESK-NS in mitigating depressive symptoms and emotional blunting, as well as its tolerability in TRD subjects, compared to the standard-of-care of SSRI/SNRI plus ESK-NS. We conducted a post-hoc analysis of the REAL-ESK study. The study included twenty TRD patients, ten subjects taking Vortioxetine as the main oral antidepressant with ESK-NS, and ten subjects taking SSRI or SNRI with ESK-NS. Psychometric assessments (Montgomery-Åsberg Depression Rating Scale/MADRS, Brief Psychiatric Rating Scale/BPRS) were conducted at baseline(T0), one month(T1), and three months after the treatment initiation(T2). The combination of Vortioxetine and ESK-NS was as effective as the standard-of-care in reducing depressive symptoms, with a higher effect size in reducing emotional blunting at T2. The safety and tolerability profile of the Vortioxetine+ESK-NS combination appeared to be better, with a lower rate of treatment-emergent adverse events. The combination of Vortioxetine and ESK-NS may be a valuable alternative to the standard-of-care SSRI/SNRI plus ESK-NS in TRD patients, particularly regarding the reduction of emotional blunting and potentially a better safety and tolerability profile. Further randomized controlled trials with larger sample sizes and prospective designs are needed to confirm these findings.