Understanding Patient Profiles among Medicaid Patients with Treatment-resistant Depression Initiated on Esketamine

This work was sponsored by Janssen Scientific Affairs, LLC BACKGROUND: Real-world data studies on esketamine use for treatment-resistant depression (TRD) in the US have previously focused on commercially-insured patients. This study aims to fill the knowledge gap regarding esketamine use for TRD in the diverse Medicaid population. METHODS: Medicaid-insured adults with evidence of TRD (≥2 unique antidepressants of adequate dose and duration) initiating esketamine (index date) were selected from Merative™ MarketScan® Multi-State Medicaid Database (01/2016-06/2022). Patient characteristics were described in the 12-month pre-index (baseline) period and esketamine use was described during the post-index (follow-up) period. RESULTS: Among 151 patients initiating esketamine, mean age was 40.6 years, 70.2% were females, 31.1% belonged to racially minoritized populations, 20.5% had evidence of suicidal ideation or probable attempt, 30.5% had substance-related/addictive disorders and obesity. During the baseline period, 62.3% claimed ≥3 unique antidepressants, 54.3% claimed antipsychotics. During the follow-up period (mean: 13.2 months), patients had a mean of 22.5 esketamine sessions; among 67.5% who completed esketamine induction (≥8 sessions), half did so within 30.5 days (per label, 28 days); 62.3% continued treatment post induction, and 53.0% completed ≥4 maintenance sessions. CONCLUSION: Medicaid beneficiaries with TRD initiating esketamine have a high proportion of racially minoritized populations and high comorbidities prevalence. Half who completed induction did so within the time per-label, and most progressed to esketamine maintenance. Collaboration between payers, providers, and patients could help overcome some barriers potentially explaining why some patients had suboptimal treatment adherence and did not reach esketamine maintenance.