Patient preferences for ketamine-based antidepressant treatments in treatment-resistant depression: Results from a clinical trial and panel
A. Fairchild, E. Katz, S. Reed, F. Johnson, A. Dibernardo, D. Hough, Jaskaran Sing, B. Levitan
Neurology Psychiatry and Brain Research September 1, 2020 DOI: 10.1016/j.npbr.2020.05.003 via Semantic Scholar
Summary
Most people with treatment-resistant depression and a general online sample were willing to accept substantial long-term risks, including ulcerative cystitis and cognitive impairment, to achieve meaningful improvements in depression symptoms. In a survey, 54% of patients who had used esketamine and 64% of panel respondents accepted benefit-risk tradeoffs. They valued improving depression symptoms most highly and were least concerned about avoiding transient post-dose issues like dissociation or dizziness. On average, clinical-trial participants accepted risks of ulcerative cystitis up to 5% or higher to see their depression improve from severe to moderate, while panel respondents accepted somewhat lower risks, though the difference was not statistically significant.
Study at a glance
| Characteristics | Discrete-choice experiment Peer reviewed |
|---|---|
| Sample size | 462 |
| Population | Esketamine-treated treatment-resistant depression subjects and online panel participants |
| Keywords | Medicine Psychology |
| Citations | 14 |
| Key finding | Most participants accepted substantial risks of ulcerative cystitis or cognitive impairment to achieve depression improvement, with transient post-dose issues being of relatively little concern. |
Abstract
Abstract Background Novel ketamine-based pharmacotherapies can reduce depressive symptoms among patients with treatment-resistant depression (TRD), but associated short-term symptoms and potential adverse events raise complex benefit-risk questions. Methods A web-based discrete-choice experiment was administered to 161 esketamine-treated TRD subjects participating in the SUSTAIN-2 and SUSTAIN-3 clinical-trials; and to 301 online panel participants. Participants evaluated hypothetical depression treatments defined by varying levels of improvement in depression symptoms; time to response; transient post-dose issues (dissociation, dizziness, monitoring requirements, and driving restrictions); and potential long-term risks of ulcerative cystitis and cognitive impairment previously reported from ketamine abuse. Results The clinical-trial and panel respondents had similar preferences. On average, the 54 % of clinical-trial and 64 % of panel respondents who accepted benefit-risk tradeoffs placed the highest value on improving depression symptoms (relative importance = 10) and the least importance on avoiding transient post-dose issues (relative importance 5.0 %] or ulcerative cystitis higher than the survey’s maximum 5 % level to improve their depression symptoms from MADRS-40 (severe) equivalent to MADRS-20 (moderate) equivalent; panel respondents accepted somewhat lower risks (P>.05). Conclusions Most patients and panelists indicated a willingness to accept significant ulcerative cystitis or cognitive risks to realize improvements in depression, with few differences between samples. Avoiding transient post-dose issues with esketamine was of relatively little concern to most participants.