ADVERTISEMENT
Secondary Analysis Shows Which Patients With TRD Benefit Most From Ketamine
Ketamine was associated with greater treatment response than electroconvulsive therapy (ECT) in patients with nonpsychotic treatment-resistant depression (TRD) who had moderately severe or severe pretreatment symptoms and who initiated treatment as outpatients, according to a secondary analysis of a randomized clinical trial published in JAMA Network Open.
“The ELEKT-D: ECT vs Ketamine in Patients With TRD (ELEKT-D) trial demonstrated noninferiority of intravenous ketamine vs ECT for nonpsychotic TRD,” wrote Manish Kumar Jha, MBBS, of UT Southwestern Medical Center, Dallas, Texas, and coauthors in the study background. “Clinical features that can guide selection of ketamine vs ECT may inform shared decision-making for patients with TRD.”
Related: One in 7 Patients Experience Antidepressant Discontinuation Symptoms, Study Says
ELEKT-D was an open-label, noninferiority trial that randomized patients to either 6 ketamine infusions or 9 ECT treatments over 3 weeks. For the secondary analysis, researchers looked at a slate of baseline factors as well as treatment responses in 365 participants. Among them, 195 patients were from the ketamine group and 170 were from the ECT group.
Ketamine was associated with a greater reduction in 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16) score than ECT in patients with a baseline QIDS-SR16 score of 20 or less (−7.7 vs −5.6 points) and those starting treatment as outpatients (−8.4 vs −6.2 points), according to the study.
On the other hand, ECT was linked with a greater QIDS-SR16 score reduction earlier in the treatment course than ketamine (−8.4 vs −6.7 points) in patients with a baseline QIDS-SR16 score higher than 20, indicating very severe depression, and those starting treatment as inpatients. By the end of the 3-week period, however, scores were similar between treatments in the patient subgroup: −9.0 with ECT and −9.9 with ketamine.
The study also found that, in the ECT group alone, patients who scored higher on measures of premorbid intelligence and with comorbid posttraumatic stress disorder had a greater reduction in Montgomery-Asberg Depression Rating Scale score.
“While the primary study of ELEKT-D demonstrated noninferiority of ketamine compared with ECT, this study suggests that ketamine may be especially preferred over ECT among those with TRD who have moderately severe or severe depression or who are initiating treatment as outpatients,” researchers wrote. “Furthermore, use of an estimate of premorbid intelligence (such as the North American Adult Reading Test-35) may be informative.”
Reference
