The efficacy and safety of adjunctive intranasal esketamine treatment in major depressive disorder: a systematic review and meta-analysis
Muhammad Youshay Jawad, Joshua D. Di Vincenzo, Felicia Ceban, Saja Jaberi, Leanna M.W. Lui, Emily S. Gillissie, Yazen Alnafeesi, Joshua D. Rosenblat, Roger S McIntyre
Expert Opinion on Drug Safety April 6, 2022 DOI: 10.1080/14740338.2022.2058488 (opens in new tab) via OpenAlex
Summary
AI-generated from the abstractIntranasal esketamine, when added to an oral antidepressant, is safe and more effective than a placebo nasal spray at reducing depressive symptoms in people with treatment-resistant depression and depression with suicidal thoughts or behavior. Pooling data from seven randomized controlled trials showed a small but significant improvement in depressive symptoms, with higher rates of response and remission. Year-long studies found lower relapse rates and no major long-term side effects. The treatment appears well tolerated and rapidly effective for these difficult-to-treat populations.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Population | Patients with treatment-resistant depression or depression with suicidal ideation and behavior |
| Intervention | Intranasal esketamine |
| Duration | At least 4 weeks, with year-long trials included |
| Topics | Depression |
| Keywords | Depression economics Placebo Suicidal ideation |
| Citations | 29 |
| Key finding | Adjunctive intranasal esketamine was safe and more effective than intranasal placebo at reducing depressive symptoms, with higher response and remission rates and lower relapse rates over one year. |
Abstract
INTRODUCTION: Intranasal (IN) esketamine represents an innovative treatment for individuals with treatment resistant depression and depression with suicidal ideation and behavior. Herein, we synthesize extant long-term studies (≥ 4 weeks) regarding this treatment. RESEARCH DESIGN AND METHODS: The interventional studies of IN esketamine in patients with depression having a study period of at least four weeks were included for our synthesis. A meta-analysis was undertaken for the efficacy and safety parameters of adjunctive IN esketamine vs IN placebo with an oral antidepressant. The data excluded from meta-analysis were synthesized narratively. RESULTS: After pooling data from seven randomized controlled trials, treatment with adjunctive IN esketamine vs IN placebo was safe overall, and more effective at decreasing depressive symptoms (d = -0.239; 95%CI = -0.335,-0.142;p < 0.0001), with higher response (RR = 1.221; 95% CI = 1.055,1.428; p = 0.017) and remission (RR = 1.366; 95% CI = 1.182,1.578; p < 0.0001) rates. The year-long trials showed that treatment with adjunctive IN esketamine led to lower relapse rates with no considerable long-term side effects. CONCLUSION: Intranasal esketamine was demonstrated to be safe, well tolerated, and rapidly effective in individuals with treatment resistant depression, suicidal ideation, and suicidal behavior.