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Treatment Response With Esketamine Nasal Spray Plus an Oral Antidepressant in Patients With Treatment-Resistant Depression Without Evidence of Early Response

Ibrahim Turkoz, Ella Daly, Jaskaran Singh, Xiwu Lin, Yevgen Tymofyeyev, David Williamson, Giacomo Salvadore, Abigail I. Nash, Matthew Macaluso, Samuel T. Wilkinson, J. Craig Nelson

The Journal of Clinical Psychiatry July 16, 2021 DOI: 10.4088/jcp.20m13800 (opens in new tab)

Study at a glance

AI-extracted from the abstract
Characteristics Pooled post hoc analysis of two phase 3, double-blind, active-controlled studies Peer reviewed
Population Patients with treatment-resistant depression
Duration 4-week induction course
Topics Anxiety Depression Esketamine
Keywords Antidepressant Depression economics Nasal spray Anesthesia Nasal administration Pharmacology
Citations 21
Registration NCT02417064 NCT02418585
Key points Patients with treatment-resistant depression who did not respond within the first week of treatment may still benefit from a full 4-week induction course of esketamine nasal spray.

Abstract

) and treatment-resistant depression (TRD) who did not meet response criteria within the first week of treatment. The current study is a pooled post hoc analysis of two phase 3, double-blind, active-controlled studies, conducted between August 2015 and February 2018, comparing ESK + AD with an oral antidepressant plus placebo (AD + PBO). Early treatment response was defined as a ≥ 50% decrease in Montgomery-Åsberg Depression Rating Scale total score at day 2 or days 2 and 8. Response rates at day 28 were determined among those not meeting early response criteria. = .01). In nonresponders at day 2 and at days 2 and 8, the odds ratio for a response at day 28 was 1.61 (95% CI, 1.09-2.40) with ESK + AD versus 1.56 (95% CI, 1.04-2.35) with AD + PBO. Patients with TRD without a demonstrated response within the first week of treatment may still derive benefit from a full 4-week induction course of esketamine nasal spray. ClinicalTrials.gov identifiers NCT02417064 and NCT02418585.

In the evidence

This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.

  • Patients not responding within the first week of treatment still showed higher odds of response at day 28 with esketamine plus antidepressant than with antidepressant plus placebo.

    Synthesized

Comparable studies

Other randomized controlled trials on esketamine for anxiety, most cited first.

Study Year Design Participants
Meaningful Change in Depression Symptoms Assessed with the Patient Health Questionnaire (PHQ-9) and Montgomery-Åsberg Depression Rating Scale (MADRS) Among Patients with Treatment Resistant Depression in Two, Randomized, Double-blind, Active-controlled Trials of Esketamine Nasal Spray Combined With a New Oral Antidepressant Patients with treatment resistant depression 2020 Randomized controlled trial
Predictors of response and remission in patients with treatment-resistant depression: A post hoc pooled analysis of two acute trials of esketamine nasal spray Patients with treatment-resistant depression 2023 Post hoc analysis of two pooled phase 3 double-blind placebo- and active-controlled trials n = 518
Assessment of health-related quality of life and health status in patients with treatment-resistant depression treated with esketamine nasal spray plus an oral antidepressant Patients aged 18-64 years with treatment-resistant depression 2023 Phase 3, randomized, double-blind, short-term flexibly dosed study n = 223
The effect of esketamine on postoperative anxiety and depression in patients with thyroid cancer: A randomized, double-blind, placebo-controlled, parallel-group trial. Female patients with thyroid cancer scheduled for surgery under general anesthesia 2025 Randomized controlled trial n = 80
Preoperative Anxiety's Impact on the Median Effective Dose of Esketamine for Alleviating Propofol Injection Pain in Patients Undergoing Painless abortion: A Randomized, Double-Blind, Controlled Trial. Patients scheduled for painless abortion 2024 Randomized controlled trial n = 150

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