Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression
RCT (n=676) found addition of esketamine nasal spray to an SSRI or SNRI to be superior to addition of extended-release quetiapine with respect to remission at week 8 (91 of 336 [27.1%] vs 60 of 340 [17.6%]; p=0.003). Adverse events were consistent with established safety profiles
Source:
New England Journal of Medicine
SPS commentary:
An editorial points out neither drug did particularly well with respect to the primary end point, although esketamine nasal spray was more efficacious and associated with fewer adverse events that led to discontinuation of the trial treatment. It notes that once patients have not had a response to at least two antidepressants, the achievement of full remission within 2 months with further drug treatment remains unlikely. It adds that although patience is valuable, speed in resolving depression is also important. It suggests this trial supports the radical and disruptive idea that esketamine nasal spray has a place early in the sequence of antidepressant treatment, and seems to help prevent depression from consolidating its grip.