Effects of esketamine on patient-reported outcomes in major depressive disorder with active suicidal ideation and intent: a pooled analysis of two randomized phase 3 trials (ASPIRE I and ASPIRE II).
Carol Jamieson, Carla M. Canuso, Dawn F. Ionescu, Rosanne Lane, Xin Qiu, Heather Rozjabek, Patricio Molero, Dong-Jing Fu
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation November 2023 DOI: 10.1007/s11136-023-03451-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pooled analysis of two phase 3 randomized controlled trials Double-blind Peer reviewed |
|---|---|
| Sample size | 451 |
| Population | Adults aged 18-64 years with major depressive disorder having active suicidal ideation with intent |
| Interventions | Esketamine nasal spray standard of care |
| Duration | Double-blind treatment phase through day 25 |
| Measures | Beck Hopelessness Scale (BHS), Quality of Life in Depression Scale (QLDS), European QoL Group-5-Dimension-5-Level (EQ-5D-5L), 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) |
| Topics | Depression Esketamine |
| Keywords | Patient-reported outcomes Pooled analysis Suicidal ideation |
| Registration | NCT03039192 NCT03097133 |
| Key findings | Esketamine plus standard care was associated with greater improvement in quality-of-life scores than placebo plus standard care at day 25 (least-squares mean difference -3.1, 95% CI -5.21 to -1.02), while changes in hopelessness were similar between groups (-1.0, 95% CI -2.23 to 0.21). Treatment satisfaction for effectiveness and global satisfaction was higher with esketamine, and the authors state these patient-reported outcomes support the patient perspective of improved health-related quality of life. |
Abstract
To assess the effect of esketamine nasal spray on patient-reported outcomes (PROs) in patients with major depressive disorder having active suicidal ideation with intent (MDSI). Patient-level data from two phase 3 studies (ASPIRE I; ASPIRE II) of esketamine + standard of care (SOC) in patients (aged 18-64 years) with MDSI, were pooled. PROs were evaluated from baseline through end of the double-blind treatment phase (day 25). Outcome assessments included: Beck Hopelessness Scale (BHS), Quality of Life (QoL) in Depression Scale (QLDS), European QoL Group-5-Dimension-5-Level (EQ-5D-5L), and 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9). Changes in BHS and QLDS scores (baseline to day 25) were analyzed using a mixed-effects model for repeated measures (MMRM). Pooled data for esketamine + SOC (n = 226; mean age: 40.5 years, 59.3% females) and placebo + SOC (n = 225; mean age: 39.6 years, 62.2% females) were analyzed. Mean ± SD change from baseline to day 25, esketamine + SOC vs placebo + SOC (least-square mean difference [95% CI] based on MMRM): BHS total score, - 7.4 ± 6.7 vs - 6.8 ± 6.5 [- 1.0 (- 2.23, 0.21)]; QLDS score, - 14.4 ± 11.5 vs - 12.2 ± 10.8 [- 3.1 (- 5.21, - 1.02)]. Relative risk (95% CI) of reporting perceived problems (slight to extreme) in EQ-5D-5L dimensions (day 25) in esketamine + SOC vs placebo + SOC: mobility [0.78 (0.50, 1.20)], self-care [0.83 (0.55, 1.27)], usual activities [0.87 (0.72, 1.05)], pain/discomfort [0.85 (0.69, 1.04)], and anxiety/depression [0.90 (0.80, 1.00)]. Mean ± SD changes from baseline in esketamine + SOC vs placebo + SOC for health status index: 0.23 ± 0.21 vs 0.19 ± 0.22; and for EQ-Visual Analogue Scale: 24.0 ± 27.2 vs 19.3 ± 24.4. At day 25, mean ± SD in domains of TSQM-9 scores in esketamine + SOC vs placebo + SOC were: effectiveness, 67.2 ± 25.3 vs 56.2 ± 26.8; global satisfaction, 69.9 ± 25.2 vs 56.3 ± 27.8; and convenience, 74.0 ± 19.4 vs 75.4 ± 18.7. These PRO data support the patient perspective of the effect associated with esketamine + SOC in improving health-related QoL in patients with MDSI. ClinicalTrials.gov Identifier: ASPIRE I, NCT03039192 (Registration date: February 1, 2017); ASPIRE II, NCT03097133 (Registration date: March 31, 2017).
Comparable studies
Other randomized controlled trials on esketamine for depression, most cited first.