Patients with treatment-resistant depression who received esketamine combined with a serotonin-norepinephrine reuptake inhibitor had lower risks of death, hospitalizations, and relapse compared with those who received esketamine with a selective serotonin reuptake inhibitor, according to a recent study.
The retrospective cohort study used real-world data from the TriNetX health research network, analyzing 55,480 adults with treatment-resistant depression over a 5-year period. After matching for age and sex, researchers compared 27,740 patients treated with esketamine plus a selective serotonin reuptake inhibitor (SSRI) to 27,740 patients treated with esketamine plus a serotonin-norepinephrine reuptake inhibitor (SNRI).
All-cause mortality was lower in the esketamine plus SNRI group (5.3%) than in the esketamine plus SSRI group (9.1%). Hospitalizations were also less frequent in the esketamine plus SNRI group (0.1% vs 0.2%). Depression relapses occurred in 14.8% of the esketamine plus SNRI group compared to 21.2% of the esketamine plus SSRI group. However, suicide attempts were lower in the esketamine plus SSRI group (0.3%) compared to the esketamine plus SNRI group (0.5%).
Overall, mortality, hospitalizations, depression relapses, and suicide attempts were low across both groups during the study period.
Kaplan-Meier survival analysis showed a 5-year survival probability of 91.4% for the esketamine plus SNRI group compared with 86.9% for the esketamine plus SSRI group. The difference in survival was statistically significant.
Patients included in the study had failed to respond to at least two prior antidepressant treatments. Esketamine was administered as a nasal spray in combination with either an SSRI or an SNRI.
"These findings emphasize the critical role of selecting the appropriate antidepressant partner for esketamine and tailoring treatment to an individual patient profile," said Antonio del Casale, MD, from the Faculty of Medicine and Psychology, Sapienza University of Rome, Italy, and colleauges.
Data were drawn from electronic health records across more than 90 health care centers in 20 countries. Propensity score matching was used to balance the two cohorts by age and sex.
While the study found differences in outcomes between SSRI and SNRI combinations, "further randomized clinical trials and quality-of-life assessments are needed to confirm these findings and optimize treatment strategies," noted Dr. Casale and colleagues.
No competing interests were reported.
Source: JAMA Psychiatry