(esketamine)
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Last Updated: 12/19/2023
Retrospective analysis of data sourced from a large cross-sectional database in the US (the Adelphi Real World Depression Disease Specific Programme XII [DSP™]). Treatment with SPRAVATO was analyzed for its market availability, improvement in disease state and daily functioning (analyzed by the Clinician Global Impression of Improvement [CGI-I]), depression severity (analyzed by the Clinician Global Impression of Severity [CGI-S]), and satisfaction of the physician with the medication.
A retrospective, longitudinal, observational cohort study utilizing data from the PremiOM™ major depressive disorder (MDD) Dataset in the US. Severity in depressive symptoms, using the PHQ-9 scale, was compared from baseline to >0-3-month and >3-6-month periods after the index date (defined as the day of SPRAVATO initiation). Remission was defined as a follow-up PHQ-9 score of <5.
Retrospective observational cohort study utilized data collected from an electronic health record system and medical charts of a REMS-certified psychiatric clinic for SPRAVATO treatment.
Inclusion Criteria: Adults (≥18 years old) with major depressive disorder, recurrent without psychotic features and received SPRAVATO between July 2019-June 2021.
Exclusion Criteria: Patients who had received any other form of ketamine were excluded.
Primary outcomes assessed were PHQ-9 depression scores, GAD-7 anxiety scores and suicidal ideation (SI) score, item 9 on PHQ-9.
The mean age of the 171 treated patients was 36 years. Most patients were white (92%), and predominantly female (60.0%), and had comorbid psychiatric diagnoses. Most patients (98%) used other psychiatric medications besides SPRAVATO with a mean of 5.8 (standard deviation [SD], 4.0) medications per patient, out of which there was a mean of 2.3 (SD, 2.3) ADs used per patient.
Based on the PHQ-9 and GAD-7 scores from treatment sessions 1-28, the average PHQ-9, GAD-7 and mean SI scores decreased significantly (P<0.001) from baseline suggesting improvement in severity of depression and anxiety symptoms.
The baseline mean PHQ-9 score was 16.7 (SD, 5.8) and mean GAD-7 score was 12.0 (SD, 5.8). Mean PHQ-9 and GAD-7 scores at last available SPRAVATO treatment were 12.0 (SD, 6.4) and 8.7 (SD, 5.6) showing significant reductions from baseline. There was also a significant decrease in the suicide score from a baseline of 1.09 (SD, 1.06) to 0.79 (SD, 0.94). Refer to Table: PHQ-9 and GAD-7 Scores by Number of SPRAVATO Treatments Received.
Number (n) | Score at Baseline Mean (SD) | Last Available Treatment Mean (SD) | P Valuea | |
---|---|---|---|---|
Depression - PHQ-9 | ||||
>2 survey scores and/or >2 weeks of treatment | 148 | 16.7 (5.82) | 12 (6.38) | <0.001 |
Patients with 1 treatment | 7 | 13 (6.72) | N/A | |
Patients with 2-5 treatments | 31 | 15.8 (6.85) | 14.6 (6.67) | 0.202 |
Patients with 6-10 treatments | 36 | 15.1 (5.77) | 11 (6.46) | <0.001 |
Patients with 11-15 treatments | 39 | 16.7 (5.60) | 11.2 (6.42) | <0.001 |
Patients with 16-30 treatments | 33 | 18.5 (5.00) | 11.6 (5.73) | <0.001 |
Patients with 31-71 treatments | 13 | 17.5 (5.87) | 11.9 (5.50) | 0.001 |
Anxiety - GAD-7 | ||||
All patients with baseline and >2 survey scores and/or >2 weeks of treatment | 120 | 12.0 (5.80) | 8.7 (5.62) | <0.001 |
Patients with 1 treatment | 7 | 11.3 (6.97) | N/A | |
Patients with 2-5 treatments | 28 | 11.6 (6.29) | 10.1 (6.14) | 0.023 |
Patients with 6-10 treatments | 29 | 11.3 (5.93) | 8.38 (5.20) | 0.004 |
Patients with 11-15 treatments | 34 | 12.0 (6.01) | 8.5 (6.04) | 0.001 |
Patients with 16-30 treatments | 31 | 13.80 (5.15) | 9.58 (5.81) | <0.001 |
Patients with 31-71 treatments | 9 | 10.67 (5.81) | 7.11 (3.48) | 0.049 |
Abbreviations: GAD-7, Generalized Anxiety Disorder-7; N/A, not applicable; PHQ-9, Patient Health Questionnaire-9; SD, standard deviation.aTwo-sample paired t-tests were conducted. |
Information from REMS documents were used to account for the number of patients experiencing AEs including sedation, dissociation, and increased blood pressure (BP). Dissociation (73%) occurred more frequently than sedation (22%) with most symptoms presenting within the first 30 minutes of SPRAVATO administration and resolving by 2 hours. Patients were reported to be ready to leave approximately 90 minutes after dosing. Mean BP slightly decreased over time throughout each treatment session. There was 1 serious AE reported in which a patient experienced prolonged dissociation, sedation, nausea, and vomiting with full resolution occurring the same day before leaving the center.
This retrospective, observational, multicenter study analyzed patients as part of an “early access programme” in Italy that supplied SPRAVATO to major centers treating TRD across the country.
Inclusion Criteria: Adults (≥18 years old) with TRD:
Exclusion Criteria: Patients with comorbid organic pathologies (untreated arterial hypertension or previous cerebrovascular disorders) that were considered contraindications for SPRAVATO.
Primary outcomes were assessed using MADRS and HAM-D-21 scale scores. Response was defined as 50% reduction from baseline in either score and remission defined as MADRS score of <10 or HAM-D-21 score of <7.
The mean age of the 116 treated patients was 50 years and 52.6% of patients were female. Refer to Table: Baseline Demographic and Clinical Characteristics. Psychiatric comorbidities included personality disorders (15%), substance use disorder (6%), and general anxiety disorder (5%), among others.
Total (N=116) | |
---|---|
Age, years, mean (SD) | 50 (12.45) |
Duration of depression, years, mean (SD) | 19 (11.05) |
Number of adequate antidepressant trials, lifetime, n, mean (SD) | 3.28 (1.89) |
Baseline clinical measures, mean (SD) | |
MADRS | 35 (8.53) |
HAM-D-21 | 27.7 (8.48) |
HAM-A | 25.42 (11.91) |
Suicidality: MADRS item10 | 2.16 (1.57) |
Female, n (%) | 61 (52.6) |
SPRAVATO dosage, 1 month (n=106), n (%) | |
28 mg | 8 (7.5) |
56 mg | 70 (66) |
84 mg | 28 (26.5) |
SPRAVATO dosage, 3 months (n=91), n (%) | |
28 mg | 8 (8.8) |
56 mg | 48 (52.7) |
84 mg | 35 (38.5) |
Previous suicidal attempts? n (%) | |
No | 87 (77.7) |
Yes | 25 (22.3) |
Abbreviations: HAM-A, Hamilton Rating Scale for Anxiety; HAM-D-21, Hamilton Rating Scale for Depression-21; MADRS, Montgomery-Åsberg Depression Rating Scale; SD, standard deviation. |
A significant reduction in the MADRS score was observed at T1 (n=106; mean, 22.27±9.81; P<0.0001) and T2 (n=91; mean, 14.69±9.88; P<0.0001) compared to baseline ([T0]; mean, 35±8.53). Furthermore, SPRAVATO had a significant effect (P<0.0001) in reducing suicidal thoughts (MADRS item 10) at T1 (mean, 1±0.55) and T2 (mean, 0.94±0.1) compared to baseline (mean, 2.13±1.58). Compared to T0, there was an increase in clinical response (T1, 28.4%; T2, 64.2%) and remission (T1, 11.2%; T2, 40.6%) with significant improvement in both at T2 vs T1 (P<0.0001).
SPRAVATO had similar effectiveness irrespective of psychiatric comorbidities. However, patients on medications other than ADs, such as antipsychotics or mood stabilizers, showed an overall lower response rate to SPRAVATO (T1, P=0.023; T2, P=0.010).
Dissociation (39.7%), sedation (28.4%), and transient hypertension (10.3%) were the most common side effects, whereas 27.6% of patients reported no side effects. Three patients (2.58%) discontinued because of severe side effects at T1.
A total of 24 patients were included, of which 66.7% (n=16) were female. The mean age was 53.4 years. Eligible patients had failed to respond to 2 or more “proper AD trials”, 1 augmentation or potentiation strategy and a non-pharmacological treatment such as electroconvulsive therapy (ECT). Approximately 42% (n=10) had already received treatment with ECT.
The HAM-D-17, MADRS and visual analogue scale for depression were measured at baseline and at 3 and 6 months. To compare different depression rating scales, t-scores were calculated and a mixed linear general model for repeated measures was used for mean comparison at different time points.
A statistically significant decrease in the mean depression t-scores (F(1,8)=227.6, P<0.001) was observed when comparing baseline (mean=59.15, standard error [SE]=2.52) to 3-month scores (mean=41.10, SE=3.07, P<0.001) and baseline to 6-month scores (mean=36.99, SE=4.27, P<0.001). Response was achieved in 60% (n=12) and remission in 30% (n=6) of patients. The authors did not define response and remission criteria.
Two patients discontinued treatment due to no therapeutic effect after 6 months of treatment. Feelings of dizziness, dissociative symptoms, irritability, and tiredness were each reported by 4% (n=1) of individuals, with no reported adverse effects in the remainder of patients. The investigators did not report the timing of AE occurrences.
Inclusion Criteria: Adults (≥18 years old) with moderate to severe depression and:
Treatment access request forms were completed by treating psychiatrists and sent to the sponsor from September 23, 2019, until March 25, 2020, and in total 66 patients were treated by 36 psychiatrists at 25 centers in France, of whom 54 had documented exposure to SPRAVATO.
Patients received SPRAVATO with an AD according to the Summary of Product Characteristics approved by the ANSM in a hospital setting for both in- and outpatients, and patients were monitored for approximately 2 hours by a healthcare professional following each treatment session.
The mean age of the 66 treated patients was 52.5 years and the majority were female (62.1%). The mean MADRS total score was 32.9.
Of the 49 patients with a completed treatment initiation form and available data, treatment was initiated in a complete hospitalization setting in 27 (55.1%) patients and in day hospitalization in 22 (44.9%) for treatment administration purposes. SPRAVATO was initiated with AD monotherapy in 16 (28.1%) patients, AD plus augmentation therapy in 9 (15.8%), combination therapy with 2 ADs in 17 (29.8%), and combination therapy plus augmentation in 15 (26.3%). In 47 patients with cumulative data, the median treatment exposure time to SPRAVATO was 30.0 (range, 10-148) days. The mean (SD) duration of monitoring following SPRAVATO administration was 123.3 minutes (25.4), performed mainly by nurses.
MADRS total score reporting was not mandatory but at least 2 scores were reported during the induction period for 46 patients. Of the 46 patients, 25 had scores at the end of induction. Mean MADRS total scores decreased from a baseline score 30.9 to a score of 19.5 by week 4. Of the 46 patients, 22 (47.8%) achieved a response (decrease of ≥50% in the MADRS total score) at least once after treatment initiation (median time to response,18.5 [range, 2-77] days). Of these patients, 17 achieved remission (MADRS total score ≤12) at least once after treatment initiation (median time to remission, 21 [range, 2-46] days). Most patients were using 56 mg of SPRAVATO at the time of response and remission (see Table: Proportion of Patients Receiving 56 mg or 84 mg at the Time of Response, Remission, and Treatment Discontinuation due to Lack of Efficacy). Four weeks following treatment, patients had a 31.6% probability of achieving remission. Using Kaplan-Meier analysis, this increased to 60.3% after 8 weeks.
At time of: | SPRAVATO 56 mg | SPRAVATO 84 mg |
---|---|---|
Response (n=22) | 68.2% | 31.8% |
Remission (n=17) | 70.6% | 29.4% |
Treatment D/C due to lack of efficacy (n=17) | 58.8% | 41.2% |
Abbreviation: D/C, discontinuation. |
There were 201 medically confirmed AEs reported in 51 patients (see Table: AEs [Including Serious AEs] Reported in ≥10% of Patients). 187 AEs were non-serious and 14 were considered serious; 8 discontinued due to AEs. All AEs associated with SPRAVATO were transient and self-limiting, and occurred on the day of administration. Overall, 13 patients experienced increased BP or hypertension after administration. Twenty-four patients discontinued after a median time from treatment initiation of 28 days (range, 15-132 days). There were no new safety signals during the ATUc compared with the phase 3 clinical trials, no deaths, and no cases of dependence.
Adverse Event | Patients, n (%) |
---|---|
Dissociation | 19 (28.8) |
Sedation | 17 (25.8) |
Somnolence | 17 (25.8) |
Dizziness | 14 (21.2) |
Anxiety | 11 (16.7) |
Increased blood pressurea | 10 (15.2) |
Nausea | 7 (10.6) |
Derealization | 7 (10.6) |
aOne patient required nicardipine and another hydrochlorothiazide. |
This interim analysis collected data from medical records of patients who had been included in the study from June 26, 2020, to January 11, 2021, and treated with SPRAVATO and an AD between October 29, 2019, and March 1, 2021. Patients were included in 1 of 3 cohorts depending upon treatment initiation date (Figure: Number of Patients Treated With SPRAVATO Overall and per Cohort).
Abbreviations: ATU(c), Temporary Authorization for Use (cohort); Q, quarter.
The mean age of the 62 treated patients was 49.2 years and the majority were female (67.7%). The median time in years from first diagnosis of depression was 9.3 (range, 3.8-20.9 years). Mean MADRS total score (SD) at baseline was 31.8 (7.3). The mean number of lines of treatment at the time of SPRAVATO initiation ranged from 3.2 to 5.2 across the 3 cohorts.
Patients were on a numerically greater number and variety of drugs compared to previous depressive episodes at the time of SPRAVATO initiation. In the current depressive episode, a higher number of patients had received neurostimulation (ECT, 73.9%; rTMS, 60.8%) in the ATUc (46.2%) and post-ATU (46.2%) cohorts compared to post launch (15%).
Responders were defined as ≥50% decrease in the MADRS total score. There was a greater reduction in the mean MADRS total score from treatment initiation and a higher number of responders in the post launch cohort compared with the other 2 cohorts (see Figure: Change in MADRS From Initiation [A] and Percentage of Responders [B]).
Abbreviations: ATU(c), Temporary Authorization for Use (cohort); MADRS, Montgomery-Åsberg Depression Rating Scale.
The odds for recording SPRAVATO responders at 1 week was 8-fold higher in patients who had 2 previously well-conducted treatment lines (n=11) in comparison to those with ≥3 (n=22) lines (P=0.027). Those with prior treatment with neurostimulation had a 4.5-fold higher likelihood of a non-satisfactory outcome (P=0.014).
There were 321 AEs in 39 patients. The majority (60%) were mild in severity. The most common AEs were ineffective therapeutic drug (33.9%), dissociative disorder (32%), somnolence (21%), and sedation (16%).
Two studies with similar recruitment conditions were selected:
Baseline characteristics were similar between the 2 studies. Subjects who stopped prior to study termination were imputed as non-responders.
Treatment differences were estimated by reweighting observations (inverse probability weighting using propensity scores estimated with 17 covariates) in the EOTC using SUSTAIN-2 as a reference, resulting in an estimate of treatment effects.
Response (≥50% improvement MADRS score) and remission (total MADRS score ≤10) at 6 months were compared. Analysis was based on observed cases.
The overall logistic regressions for response and remission showed a significant odds ratio (OR; both P<0.0001) in favor of SPRAVATO + AD (see Table: Likelihood for Response for SPRAVATO [SUSTAIN-2] vs RWT [EOTC] and Table: Likelihood for Remission for SPRAVATO [SUSTAIN-2] vs RWT [EOTC]). Results were consistent following adjustment for multiple covariates and several sensitivity analyses.
All Treatments | Monotherapy | Combination Therapy | Augmentation Therapy | |
---|---|---|---|---|
OR (95% CI) | ||||
Unadjusted | 2.90 (2.14-3.94)b | 2.87 (1.70-4.85)b | 2.72 (1.83-4.05)b | 3.13 (2.01-4.88)b |
Adjusteda | 2.85 (2.25-3.62)c | 8.23 (6.48-10.45)b | 2.98 (2.36-3.77)b | 2.83 (2.20-3.63)b |
RR (95% CI) | ||||
Unadjusted | 1.96 (1.66-2.26) | 1.94 (1.44-2.44) | 1.87 (1.50-2.23) | 2.07 (1.62-2.53) |
Adjusteda | 1.94 (1.71-2.18) | 2.86 (2.68-3.03) | 1.97 (1.75-2.20) | 1.95 (1.70-2.20) |
RD (95% CI) | ||||
Unadjusted | 0.24 (0.17-0.32) | 0.24 (0.11-0.37) | 0.23 (0.13-0.33) | 0.26 (0.15-0.37) |
Adjusteda | 0.24 (0.18-0.30) | 0.48 (0.44-0.53) | 0.25 (0.19-0.31) | 0.23 (0.17-0.30) |
NNT (95% CI) | ||||
Unadjusted | 5 (4-6) | 5 (3-9) | 5 (4-8) | 4 (3-7) |
Adjusteda | 5 (4-6) | 3 (2-3) | 4 (4-6) | 5 (4-6) |
Abbreviations: CI, confidence interval; EOTC, European Observational TRD cohort; NNT, number needed to treat; OR, odds ratio; RD, risk difference; RR, relative risk; RWT, real-world treatment.aAverage treatment effect among treated-cumulative indirect treatment comparison method. bP<0.0001. cP<0.001.Real-world treatment excludes SPRAVATO. OR>1 favors SPRAVATO. |
All Treatments | Monotherapy | Combination Therapy | Augmentation Therapy | |
---|---|---|---|---|
OR (95% CI) | ||||
Unadjusted | 2.60 (1.84-3.70)b | 2.26 (1.26-4.07)c | 2.31 (1.47-3.63)d | 3.45 (1.99-6.00)b |
Adjusteda | 2.35 (1.81-3.05)b | 6.51 (4.97-8.52)b | 2.20 (1.71-2.83)b | 2.96 (2.21-3.95)b |
RR (95% CI) | ||||
Unadjusted | 2.07 (1.62-2.57) | 1.84 (1.20-2.61) | 1.87 (1.36-2.46) | 2.63 (1.76-3.66) |
Adjusteda | 1.93 (1.60-2.29) | 3.22 (2.86-3.56) | 1.81 (1.52-2.14) | 2.35 (1.91-2.85) |
RD (95% CI) | ||||
Unadjusted | 0.17 (0.10-0.26) | 0.15 (0.04-0.29) | 0.16 (0.06-0.26) | 0.21 (0.10-0.34) |
Adjusteda | 0.15 (0.10-0.21) | 0.41 (0.35-0.47) | 0.14 (0.09-0.20) | 0.18 (0.12-0.24) |
NNT (95% CI) | ||||
Unadjusted | 6 (4-10) | 7 (4-28) | 7 (4-16) | 5 (3-11) |
Adjusteda | 7 (5-11) | 3 (3-3) | 7 (5-11) | 6 (5-9) |
Abbreviations: CI, confidence interval; EOTC, European Observational TRD cohort; NNT, number needed to treat; OR, odds ratio; RD, risk difference; RR, relative risk; RWT, real-world treatment.aAverage treatment effect among treated-cumulative indirect treatment comparison method. bP<0.0001.cP<0.01. dP<0.001. Real-world treatment excludes SPRAVATO. OR>1 favors SPRAVATO. |
The following were significantly associated with a lower likelihood of achieving response: age ≥55 at major depressive disorder diagnosis; previous treatment failures with augmentation, tricyclic antidepressants (TCAs), or other ADs.
The following were significantly associated with a lower likelihood of achieving remission: higher baseline MADRS (≥31); previous treatment failures with augmentation or TCAs.
Due to the absence of a common comparator in the 2 studies, only an indirect comparison was possible. Increased compliance and motivation to continue treatment in the SUSTAIN2 clinical trial setting may have led to potential bias in favor of SPRAVATO. In addition, higher frequency of visits in SUSTAIN2 compared with the EOTC study may have led to improved outcomes. However, increased visits are also expected in realworld clinical treatment with SPRAVATO.
In a separate search of the SPRAVATO global medical safety database, which included AEs reported from the REMS, there were 440,369 cases from the REMS reporting a total of 658,360 AEs within the same time frame. Among those cases, 2,437 (0.4%) were reported as serious. There were 147 fatal cases in 147 unique patients with 160 reported fatal events. Of the 147 cases, 136 cased reported only 1 fatal event which included 67 deaths not otherwise specified, 45 completed suicide, 3 overdose, 2 coronavirus disease 2019 (COVID-19) infection, 2 road traffic accidents, and 1 death each due aortic aneurysm, arteriosclerosis, Candida infection, cerebrovascular accident, diabetes mellitus, drug abuse, electrolyte imbalance, failure to thrive, hepatic cirrhosis, intestinal obstruction, intestinal perforation, multimorbidity, myocardial infarction, neoplasm malignant, post procedural complication, pulmonary embolism, and sepsis. Eleven remaining fatal cases which reported more than 1 fatal event: Cardiac disorder, sepsis, and COVID-19; cardiovascular disorder, multiple organ dysfunction syndrome, and cerebrovascular accident; toxicity to various agents and accidental overdose; hip fracture and gall; hallucination auditory and completed suicide; pneumonia and multiple organ dysfunction syndrome; toxicity to various agents and completed suicide; suspected suicide and alcohol use; overdose and brain injury; organ failure and COVID-19; and substance abuse and accidental overdose. The majority of deaths were assessed by Global Medical Safety as not related to SPRAVATO treatment.10
An analysis was conducted using the FAERS to identify relevant safety signals for SPRAVATO.11 A case/non-case study design was utilized in which cases were defined by reports about SPRAVATO, while non-cases were represented by AEs recorded for all other drugs in FAERS over the first year of SPRAVATO approval. If the proportion of AEs of interest was greater in cases vs non-cases, then this was considered a disproportionality signal. AEs were classified into 4 categories, according to their predictability: expected AEs with a detected signal, expected AEs without a signal, disease-related AEs, or unexpected AEs.
There was a total of 2,274 SPRAVATO-related AEs in 962 patients with 389 serious AEs, including 22 deaths. The most frequently reported AEs (≥5%) were dissociation (n=212, 9.32%), sedation (n=173, 7.6%), and drug ineffective (n=119, 5.23%). The top 3 AEs in the expected AEs with signal category based on reporting odds ratio (listed in descending order) were dissociation (n=212), sedation (n=173), and feeling drunk (n=20); in the expected AEs without a signal category were vertigo (n=5), vision blurred (n=8), and tremor (n=9); in the disease-related AEs category were self-injurious ideation (n=5), SI (n=64), and depression (n=65); and in the unexpected AEs category were dissociative disorder (n=4), autoscopy (n=6), and drug monitoring procedure not performed (n=4). The frequency of serious AEs was higher in patients receiving SPRAVATO 84 mg compared to patients receiving SPRAVATO 56 mg. Females were also more likely to suffer from serious SPRAVATO-related AEs compared to males. A sensitivity analysis using venlafaxine as a comparator for disease-related AEs identified the following signals: self-injurious ideation, SI, emotional disorder, depression, crying, and depressed mood.11
Limitations of the FAERS includes: the database contains duplicate, incomplete, and/or unverified AEs, making causality difficult to prove; AE reports are voluntary and unsolicited (which generally leads to under-reporting of AEs for most drugs) and, therefore, AE rates cannot be determined; FAERS does not include information on the patients’ baseline suicidality and illness severity (which are important risk factors for suicide-related AEs).12
A literature search of MEDLINE®
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2 | Marci CD, Karkare S, Jha MK, et al. Change in depressive symptoms following esketamine initiation among patients with treatment-resistant depression in a real-world setting. Poster presented at: Neuroscience Education Institute (NEI) Congress; November 9-10, 2023; Colorado Springs, CO. |
3 | Brendle M, Ahuja S, Valle MD, et al. Safety and effectiveness of intranasal esketamine for treatment-resistant depression: a real-world retrospective study. J Comp Eff Res. 2022;11(18):1323-1336. |
4 | Martinotti G, Vita A, Fagiolini A. Real-world experience of esketamine use to manage treatment-resistant depression: a multicentric study on safety and effectiveness (REAL-ESK study). J Affect Disord. 2022;319:646-654. |
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6 | Samalin L, Rothärmel M, Mekaoui L, et al. Esketamine nasal spray in patients with treatment-resistant depression: the real-world experience in the French cohort early-access programme. Int J Psychiatry Clin. 2022;26(4):352-362. |
7 | Samalin L, Bukowski N, Codet MA, et al. A descriptive study of treatment-resistant depression patients treated by esketamine: ESKALE study interim analysis. Poster presented at: Journées Neurosciences Psychiatrie Neurologie (JNPN); July 1-2, 2021; Paris, France. |
8 | Rive B, Oliveira-Maia AJ, Falissard B. Indirect comparison estimating the benefit of esketamine compared to distinct realworld treatment strategies for treatment resistant depression in general psychiatry. Poster presented at: Psych Congress; October 29-November 1, 2021; San Antonio, TX. |
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