The efficacy and safety of adjunctive intranasal esketamine treatment in major depressive disorder: a systematic review and meta-analysis.

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.

• Authors: 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
• Journal: Expert opinion on drug safety (Expert Opin Drug Saf) Vol. 21 Issue 6 Pg. 841-852 (Jun 2022) ISSN: 1744-764X [Electronic] England
• PMID: 35387538 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Antidepressive Agents
• Esketamine
• Ketamine

Topics

• Antidepressive Agents
• Depressive Disorder, Major (drug therapy)
• Depressive Disorder, Treatment-Resistant (drug therapy)
• Humans
• Ketamine (adverse effects)