The efficacy and safety of adjunctive intranasal esketamine treatment in major depressive disorder: a systematic review and meta-analysis
Muhammad Youshay Jawad, Joshua D. Di Vincenzo, Felicia Ceban, Saja Jaberi, Leanna M.W. Lui, Emily S. Gillissie, Yazen Alnafeesi, Joshua D. Rosenblat, Roger S. McIntyre
Expert Opinion on Drug Safety April 6, 2022 DOI: 10.1080/14740338.2022.2058488 via OpenAlex
Summary
AI-generated from the abstractIntranasal esketamine, when added to an oral antidepressant, is safe and more effective than a placebo nasal spray at reducing depressive symptoms in people with treatment-resistant depression and depression with suicidal thoughts or behavior. Pooling data from seven randomized controlled trials showed a small but significant improvement in depressive symptoms, with higher rates of response and remission. Year-long studies found lower relapse rates and no major long-term side effects. The treatment appears well tolerated and rapidly effective for these difficult-to-treat populations.
Study at a glance
| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Population | Patients with treatment-resistant depression or depression with suicidal ideation and behavior |
| Intervention | Intranasal esketamine |
| Duration | At least 4 weeks, with year-long trials included |
| Topics | Depression |
| Keywords | Depression economics Placebo Suicidal ideation |
| Citations | 29 |
| Key finding | Adjunctive intranasal esketamine was safe and more effective than intranasal placebo at reducing depressive symptoms, with higher response and remission rates and lower relapse rates over one year. |
Abstract
INTRODUCTION: Intranasal (IN) esketamine represents an innovative treatment for individuals with treatment resistant depression and depression with suicidal ideation and behavior. Herein, we synthesize extant long-term studies (≥ 4 weeks) regarding this treatment. RESEARCH DESIGN AND METHODS: The interventional studies of IN esketamine in patients with depression having a study period of at least four weeks were included for our synthesis. A meta-analysis was undertaken for the efficacy and safety parameters of adjunctive IN esketamine vs IN placebo with an oral antidepressant. The data excluded from meta-analysis were synthesized narratively. RESULTS: After pooling data from seven randomized controlled trials, treatment with adjunctive IN esketamine vs IN placebo was safe overall, and more effective at decreasing depressive symptoms (d = -0.239; 95%CI = -0.335,-0.142;p < 0.0001), with higher response (RR = 1.221; 95% CI = 1.055,1.428; p = 0.017) and remission (RR = 1.366; 95% CI = 1.182,1.578; p < 0.0001) rates. The year-long trials showed that treatment with adjunctive IN esketamine led to lower relapse rates with no considerable long-term side effects. CONCLUSION: Intranasal esketamine was demonstrated to be safe, well tolerated, and rapidly effective in individuals with treatment resistant depression, suicidal ideation, and suicidal behavior.