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Trajectory of response to esketamine nasal spray for treatment resistant depression
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Orientador(es)
Resumo(s)
Previous research has demonstrated the positive impact of early remission on disease trajectory for patients with major depressive disorder. However, there is a paucity of literature assessing response trajectory for patients with treatment resistant depression (TRD). These analyses investigated patient outcome trajectories to Week 32, including the relationship between short- and long-term outcomes with esketamine nasal spray (ESK-NS) treatment and symptom resolution. ESCAPE-TRD (NCT04338321), a randomised, open-label, phase IIIb study, evaluated the efficacy and safety of ESK-NS versus quetiapine extended release (QTP-XR) in patients with TRD. Rater-blinded Montgomery-Åsberg Depression Rating Scale (MADRS) total score was used to assess depressive symptoms and trajectory of patient responses to Week 32. For ESK-NS versus QTP-XR, time to symptom resolution across MADRS items was evaluated using Kaplan-Meier analyses. Of 676 patients, 336 and 340 were randomised to ESK-NS and QTP-XR, respectively. Most ESK-NS-treated patients achieved continuously improved outcomes to Week 32; early response was associated with better long-term outcomes. Among patients who achieved Week 4 response, 89.6% achieved remission at any point from Week 4-32; 78.3% of Week 8 responders achieved remission at any point from Week 8- 32. Greater and earlier symptom resolution was observed with ESK-NS versus QTP XR across most MADRS items. Most ESK-NS-treated patients with TRD showed continuous improvements over time, with short-term response associated with better long-term outcomes. Long-term improvements were observed even among partial/minimal early responders, reinforcing the value of longer treatment. ESK-NS had positive impact across the full 71 spectrum of MADRS-assessed symptoms.
Descrição
Publisher Copyright: © The Author(s), 2026. Published by Cambridge University Press on behalf of European Psychiatric Association.
Palavras-chave
esketamine long-term outcomes trajectory of response treatment resistant depression Psychiatry and Mental health SDG 3 - Good Health and Well-being