Effectiveness of Esketamine as a Treatment for Depression: A Real-World Survey of Disease Improvement

Introduction Major depressive disorder (MDD) is the second leading cause of disability in the US, and increases the risk of poor health outcomes. This analysis assessed the real-world benefit and availability of esketamine for patients with difficult-to-treat MDD. Methods Data were drawn from the Adelphi Real World Depression Disease Specific Programme XII (DSP TM ), a cross-sectional retrospective survey of physicians and their patients in the United States in 2022. Physicians reported details for patients with MDD receiving esketamine regarding their prescribed medication (including access), daily functioning and disease improvement whilst receiving esketamine (reported by Clinical Global Impression Improvement Scale (CGI-I)),)) change in depression severity (reported by Clinical Global Impression Severity Scale (CGI-S)) and physician satisfaction. CGI-I responses measured level of disease improvement since the initiation of current depression treatment regimen (‘Very much worse=1’ to ‘Very much improved=7’). CGI-S response options were converted to numerics to measure level of severity change (‘Normal, not at all ill=0’ to ‘Among the most extremely ill patients=6’) and compared at time of esketamine initiation and currently. Physician satisfaction with medication’s ability to achieve patient treatment goals was derived from a numeric scale (where ’Not at all satisfied=1’ to ’Very satisfied=5’). Results 94 patients with MDD were currently receiving esketamine. Mean age was 44.3 (SD 13.26) and 47% were male. 26% of patients had been receiving esketamine for 0-3 months, 5% for 3-6 months, 15% for 6-12 months, 23% for 1-2 years and 30% for more than 2 years. CGI-I results showed physicians rated depression as improved in 98% of patients receiving esketamine >30 days. CGI-S results showed that patients receiving esketamine 1-30 days had a mean improvement of 1.2 while patients receiving esketamine for >30 days showed mean improvement of 0.9. 80% of physicians reported high satisfaction (score of 4 or 5) with esketamine’s ability to achieve patient treatment goals. In patients receiving esketamine >30 days physicians reported that 62% could function better socially, 53% had a better quality of life, 41% had increased ability to work, 37% could better meet their own basic needs and 34% had an improvement in overall general health. When prescribing esketamine, the treatment was only “available without restrictions” for 18% of patients, whilst 82% experienced at least some restrictions. Conclusion Physicians reported rapid and sustained clinical improvement among patients with MDD treated with esketamine in this real-world survey. Funding The analysis described here used data from Adelphi Real World Depression DSP. The DSP is a wholly owned Adelphi Real World product. Janssen is one of the multiple subscribers to the DSP.