Improvements in health-related quality of life with esketamine nasal spray versus quetiapine extended release

TL;DR

Esketamine nasal spray improved quality of life more than quetiapine in patients with treatment-resistant depression.

Contribution

Demonstrates esketamine's superior impact on health-related quality of life in treatment-resistant depression compared to quetiapine.

Findings

Esketamine nasal spray patients reached PHQ-9 remission faster and had higher remission rates than quetiapine XR patients.

Esketamine nasal spray led to greater improvements in SF-36 domains like Mental Health and Social Functioning.

More esketamine-treated patients showed meaningful QLDS improvements and reported fewer problems in EQ-5D-5L domains.

Abstract

Clinical response and remission may not fully reflect patient priorities in treatment-resistant depression (TRD). Health-related quality-of-life (HRQoL) outcomes should be assessed to comprehensively capture treatment benefits.

ESCAPE-TRD (NCT04338321) was a 32-week randomized, phase IIIb trial comparing esketamine nasal spray (NS) versus quetiapine extended release (XR), both alongside an ongoing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor, in patients with TRD. Symptom and HRQoL improvements were assessed using the Patient Health Questionnaire-9 (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Depression Scale (QLDS), and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) measures.

Esketamine NS-treated patients (N=336) reached PHQ-9 remission (score ≤4) quicker than quetiapine XR-treated patients (N=340), and more had remission by Week 32 (34.5% vs. 18.2%; odds ratio [OR]: 2.39 [1.67, 3.41], p<0.0001). “Role Emotional”, “Mental Health”, and “Social Functioning” SF-36 domains showed significantly greater improvements in esketamine NS-treated patients compared with quetiapine XR-treated patients at Week 32 (p<0.05), returning to levels close to general population norms. More esketamine NS-treated patients had a meaningful improvement in their QLDS score by Week 32 (60.7% vs. 41.8%; OR: 2.16 [1.59, 2.94], p<0.0001), and reached this improvement quicker than quetiapine XR-treated patients. Proportions of patients reporting an EQ-5D-5L score of 1 (no problems) were significantly higher across all domains with esketamine NS versus quetiapine XR at Week 32 (p<0.05).

Esketamine NS produced superior improvements in HRQoL compared with quetiapine XR, indicating positive impacts on aspects of patients’ lives that matter to them, alongside clinical symptoms of TRD.

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