Esketamine Nasal Spray Beneficial for Treatment-Resistant Depression

THURSDAY, Oct. 5, 2023 (HealthDay News) -- For patients with treatment-resistant depression, esketamine nasal spray is superior to extended-release quetiapine with respect to remission at week 8, according to a study published in the Oct. 5 issue of the New England Journal of Medicine.

Andreas Reif, M.D., from Goethe University Hospital in Frankfurt, Germany, and colleagues conducted an open-label phase 3b randomized, active-controlled trial involving patients with treatment-resistant depression. Participants were randomly assigned to receive flexible doses of esketamine nasal spray (336 patients) or extended-release quetiapine (340 patient) both in combination with a selective serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor. The primary end point was remission, defined as a score of 10 or less on the Montgomery-Åsberg Depression Rating Scale (MADRS), at week 8.

The researchers found that more patients in the esketamine group versus the quetiapine group had remission at week 8 (27.1 versus 17.6 percent) and had no relapse through 32 weeks after remission at week 8 (21.7 versus 14.1 percent). The percentage of patients with remission, the percentage with a treatment response, and the change in the MADRS score from baseline favored esketamine over 32 weeks of follow-up.

"These results show the superiority of esketamine nasal spray to extended-release quetiapine with respect to the primary goal of antidepressant treatment in patients with a poor prognosis, in whom treatment goals are rarely met," the authors write.

The study was funded by Janssen, the manufacturer of esketamine nasal spray.

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