Long-term treatment with esketamine nasal spray in patients with treatment resistant depression: Results from the ESCAPE-LTE study.
A Reif, Yağcıoğlu Ae Anıl, I Bitter, J Buyze, R Frey, Fu Dj, Y Godinov, L Haggström, Y Kambarov, R E Nielsen, A J Oliveira-maia, C Von Holt, Young Ah, W J Cubała
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology June 1, 2026 Peer reviewed DOI: 10.1016/j.euroneuro.2026.112801 via PubMed
Summary
In a long-term study of esketamine nasal spray for treatment-resistant depression, 79.2% of patients who achieved remission did not relapse over 136 weeks. The safety profile remained consistent with short-term studies, with treatment-emergent adverse events reported in 96.7% of the 183 participants, though only 3.3% discontinued due to these events. Overall, the relapse rate for those who achieved remission was low at 6.9%, and no new safety concerns were identified.
Study at a glance
| Design | phase IV single-arm trial |
|---|---|
| Sample size | 183 |
| Population | patients with treatment-resistant depression |
| Key finding | The vast majority of patients with TRD who achieved remission with esketamine NS did not relapse over 136 weeks of treatment. |
Abstract
Optimising patient outcomes in treatment resistant depression (TRD) requires treatments which provide sustained remission, without relapse, and tolerability in the long term. ESCAPE-LTE (NCT04829318) was a phase IV, single-arm, 2-year (104 weeks) long-term extension of ESCAPE-TRD (NCT04338321; 32 weeks), a rater-blinded, randomised, active-controlled trial, which evaluated the safety, tolerability and efficacy of esketamine nasal spray (NS), alongside an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in patients with TRD. The primary endpoints were the proportion of patients who reported treatment-emergent adverse events (TEAEs) or suicidal ideation and behaviour (using the Columbia-Suicide Severity Rating Scale). Effectiveness was assessed using the Montgomery-Åsberg Depression Rating Scale, Clinical Global Impression-Severity scale, Patient Health Questionnaire-9 and EuroQol 5-Dimension 5-Level questionnaire. Outcomes are reported from ESCAPE-TRD baseline to the end of ESCAPE-LTE (136 weeks of treatment, 138 weeks including safety follow-up). In patients who entered ESCAPE-LTE (N = 183), TEAEs and serious TEAEs were observed in 96.7% and 8.2%, respectively. 98.3% of TEAEs occurring on dosing days resolved same-day; few patients discontinued due to TEAEs during ESCAPE-LTE (3.3%). 151/160 (94.4%) patients who were non-suicidal at baseline remained non-suicidal to the end of ESCAPE-LTE. In the subgroup with remission in ESCAPE-TRD, 79.2% did not relapse or discontinue treatment throughout ESCAPE-LTE; the overall relapse rate for patients achieving remission across both studies was 6.9%. The vast majority of patients with TRD who achieved remission with esketamine NS did not relapse over 136 weeks of treatment; no new safety concerns were identified, and the safety profile was consistent with short-term studies.