Long-term Safety and Efficacy of Esketamine Nasal Spray Plus an Oral Antidepressant in Patients with Treatment-resistant Depression- an Asian Sub-group Analysis from the SUSTAIN-2 Study.
Hong Jin Jeon, Po-Chung Ju, Ahmad Hatim Sulaiman, Salina Abdul Aziz, Jong-Woo Paik, Wilson Tan, Daisy Bai, Cheng-Ta Li
Clinical Psychopharmacology and Neuroscience February 28, 2022 DOI: 10.9758/cpn.2022.20.1.70 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open-label, single-arm, multicenter phase 3 study (subgroup analysis) Peer reviewed |
|---|---|
| Sample size | 78 |
| Population | Asian patients with treatment-resistant depression from Taiwan (33), Korea (26), and Malaysia (19) |
| Interventions | Intranasal esketamine oral antidepressant |
| Duration | 4-week screening, 4-week induction, 48-week optimization/maintenance, and 4-week follow-up (upon esketamine discontinuation); treatment up to one year |
| Topics | Depression Esketamine |
| Keywords | Administration Antidepressive agents Asia Intranasal Treatment-resistant |
| Key points | Long-term intranasal esketamine plus an oral antidepressant in Asian patients with treatment-resistant depression showed no new safety signals: 11.5% had at least one serious treatment-emergent adverse event, 16.7% discontinued due to adverse events, and no deaths, withdrawal syndrome, drug-seeking, abuse, or overdose occurred. Improvements in symptoms, functioning, and quality of life emerged during induction and were generally maintained, with most benefit occurring early. |
Abstract
To evaluate the long-term safety and efficacy of intranasal esketamine in patients with treatment-resistant depression from the Asian subgroup of the SUSTAIN-2 study. SUSTAIN-2 was a phase 3, open-label, single-arm, multicenter study comprising a 4-week screening, 4-week induction, 48-week optimization/maintenance, and 4-week follow-up (upon esketamine discontinuation) phase. Patients with treatment-resistant depression received esketamine plus an oral antidepressant during the treatment period. The incidence of ≥ 1 serious treatment-emergent adverse event (TEAE) among the 78 subjects from the Asian subgroup (Taiwan: 33, Korea: 26, Malaysia: 19) was 11.5% (n = 9); with no fatal TEAE. 13 Asian patients (16.7%) discontinued esketamine due to TEAEs. The most common TEAEs were dizziness (37.2%), nausea (29.5%), dissociation (28.2%), and headache (21.8%). Most TEAEs were mild to moderate in severity, transient and resolved on the same day. Upon discontinuation of esketamine, no trend in withdrawal symptoms was observed to associate long-term use of esketamine with withdrawal syndrome. There were no reports of drug seeking, abuse, or overdose. Improvements in symptoms, functioning and quality of life, occurred during in the induction phase and were generally maintained through the optimization/maintenance phases of the study. The safety and efficacy of esketamine in the Asian subgroup was generally consistent with the total SUSTAIN-2 population. There was no new safety signal and no indication of a high potential for abuse with the long-term (up to one year) use of esketamine in the Asian subgroup. Most of the benefits of esketamine occurred early during the induction phase.
Comparable studies
Other non-randomized and open-label trials on esketamine for depression, most cited first.
Citations in the library
Cited by 17
- Ketamine and the neurobiology of depression: Toward next-generation rapid-acting antidepressant treatments Proceedings of the National Academy of Sciences November 27, 2023
- Facts and myths about use of esketamine for treatment-resistant depression: a narrative clinical review. Frontiers in Psychiatry 2024
- Safety and tolerability of intramuscular and sublingual ketamine for psychiatric treatment in the Roots To Thrive ketamine-assisted therapy program: a retrospective chart review. Therapeutic Advances in Psychopharmacology 2023
- The Effects of Ketamine and Esketamine on Measures of Quality of Life in Major Depressive Disorder and Treatment-Resistant Depression: A Systematic Review. Journal of Affective Disorders August 1, 2025
- Ketamine-From an Anesthetic to a Psychiatric Drug: Mechanisms of Action, Clinical Applications and Potential Risks. Molecules June 30, 2025
and 12 more in the library
Cites 7
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
- Measurement of dissociative states with the Clinician‐Administered Dissociative States Scale (CADSS) Journal of Traumatic Stress 1998
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1) The International Journal of Neuropsychopharmacology July 9, 2019
- Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression The Journal of Clinical Psychiatry April 20, 2020
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