Early effects predict trajectories of response to esketamine in treatment-resistant depression.
Isaure Estrade, Anne-Cécile Petit, Vincent Sylvestre, Michel Danon, Sylvain Leroy, Rebecca Perrain, Fabien Vinckier, Lila Mekaoui, Raphaël Gaillard, Emmanuelle Advenier-Iakovlev, Rossella Letizia Mancusi, Daphnée Poupon, Pierre De Maricourt, Philip Gorwood
Journal of Affective Disorders September 20, 2023 DOI: 10.1016/j.jad.2023.09.030 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Longitudinal observational study Placebo-controlled Peer reviewed |
|---|---|
| Sample size | 105 |
| Population | Patients with unipolar or bipolar treatment-resistant depression treated with esketamine in real-world settings |
| Intervention | Esketamine |
| Duration | 90-day trajectory of response |
| Measures | Montgomery-Åsberg Depression Rating Scale (MADRS) |
| Topics | Depression Esketamine Ketamine |
| Keywords | Humans Antidepressive agents Treatment outcome Administration, intranasal Longitudinal studies Double-blind method Depressive disorder, treatment-resistant Response Antidepressant |
| Key findings | Two trajectories of response to esketamine were identified: response and non-response, validated in a confirmatory sample. The MADRS score after only two esketamine administrations predicted the 90-day trajectory of response with 80% accuracy. Baseline characteristics such as concomitant benzodiazepine medication, number of depressive episodes, and polarity influenced class membership. |
Abstract
Background: The efficacy of esketamine in treatment-resistant depression (TRD) has been confirmed. However, its administration is expensive and restrictive, with limited knowledge on how long the treatment should be continued. Predicting the treatment outcome would benefit patients and alleviate the global treatment cost. We aimed to define distinct trajectories of treatment response and assess their predictability.
Methods: In this longitudinal study, two independent samples of patients with unipolar or bipolar TRD were treated with esketamine in real-world settings. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) before each esketamine administration. Latent class analyses were used to define trajectories of response.
Results: In the original sample (N = 50), we identified two classes whose trajectories depicted response and non-response, respectively. The model was validated in the confirmatory sample (N = 55). Class membership was influenced by a few baseline characteristics such as concomitant benzodiazepine medication, number of depressive episodes or polarity. On the other hand, after only two esketamine administrations, the MADRS score predicted the 90-day trajectory of response with an accuracy of 80 %.
Limitations: This observational study is not placebo-controlled. Therefore, its results and their generalizability need to be confirmed in experimental settings.
Conclusions: After the first administrations of esketamine, the MADRS score has a good capacity to predict the most plausible trajectory of response. While thresholds and their predictive values need to be confirmed, this finding suggests that clinicians could base on MADRS scores their decision to discontinue treatment because of poor remaining chances of treatment response.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.