Clinical effectiveness and persistence on esketamine nasal spray in patients with treatment-resistant depression overall and among transcranial magnetic stimulation-naïve subgroup
BACKGROUND: Esketamine nasal spray and transcranial magnetic stimulation (TMS) are used for treatment-resistant depression (TRD), but little is known about the sequence in which these therapies should be considered. This analysis explored if clinical effectiveness and persistence on esketamine in TRD differ depending on previous TMS experience.
METHODS: Adults with TRD, overall and a subgroup without previous TMS experience, initiated esketamine (first session=index date) at Mindful Health Solutions clinics during 03/2019-01/2024. Baseline Patient Health Questionnaire (PHQ)-9 score was the most recent score before or on the index date. Follow-up period spanned index date until end of patient clinical activity or data. Mean change in PHQ-9 score from baseline, based on scores within 14 days after esketamine sessions was estimated with generalized estimating equations. Esketamine persistence (no gaps of >60 days between sessions) was described using Kaplan-Meier survival analysis.
RESULTS: Among all patients (Nf911) and the TMS-naïve subgroup (Nf512), baseline PHQ-9 score was 16.3 and 15.6, mean follow-up duration was 12.8 and 12.5 months. Mean differences in PHQ-9 score from baseline in all patients and the TMS-naïve subgroup were -4.0 and -4.4 after 8 sessions, -4.6 and -4.9 after 12 sessions, -5.7 and -5.8 after 28 sessions, and -5.9 and -6.0 after 52 sessions, respectively (all p < 0.001). Median persistent time on treatment was over 7 months (overall: 7.2; TMS-naïve: 7.5).
CONCLUSIONS: Sustained esketamine treatment was associated with improvement in depressive symptoms. Findings from descriptive analysis suggest that while TMS experience does not hinder esketamine effectiveness, TMS-naïve patients may improve faster.
