Treatment Patterns among Patients with Major Depressive Disorder and Acute Suicidal Ideation or Behavior Initiated on Esketamine or Traditional Therapies in the United States

Abstract: BACKGROUND: Treatment patterns among adults with major depressive disorder with suicidal ideation or behavior (MDSI) started on esketamine or traditional therapies were described to understand treatment profiles. METHODS: Adults diagnosed with MDSI selected from IBM® MarketScan® Commercial Database (01/2016-01/2022) were classified into esketamine, electroconvulsive therapy (ECT), antipsychotic augmentation (AP) and antidepressant monotherapy (AD) cohorts based on treatments initiated on or after 08/05/2020 (esketamine approval for MDSI). Esketamine use and other treatment patterns were described post-treatment initiation. RESULTS: A total of 122, 336, 9,958, and 4,496 patients were included in the esketamine, ECT, AP and AD cohorts. Mean follow-up duration was 6.5, 7.9, 7.9, and 7.5 months, respectively. Patients in the esketamine cohort had a mean of 10.9 treatment sessions, 51.6% of patients completed ≥8 sessions with the mean time to the 8th session of 56.5 days (per label, 8 sessions in 28 days). Concurrently, antidepressant claims were observed in 82.0%, 85.4%, 94.3%, and 100.0%, with a mean of 1.6, 2.0, 1.8, and 1.3 unique antidepressant agents for the esketamine, ECT, AP and AD cohorts, respectively. The proportions of those receiving ≥3 unique antidepressants were 19.7%, 30.7%, 21.2%, and 4.7%, and psychotherapy use was reported in 78.7%, 72.0%, 64.4%, and 48.2% of the esketamine, ECT, AP, and AD cohorts, respectively. CONCLUSION: Over half of the esketamine cohort completed the number of induction sessions; completion time exceeded label recommendation. Patients in the esketamine cohort claimed fewer unique antidepressants, but more psychotherapy compared to the ECT and AP cohorts.Short Description: Treatment profiles of adults with major depressive disorder with acute suicidal ideation or behavior (MDSI) initiated on esketamine, electroconvulsive therapy (ECT), antipsychotic augmentation (AP), and antidepressant monotherapy were described. Over half of the esketamine cohort completed the number of esketamine treatment induction sessions recommended per label. The esketamine cohort claimed fewer unique antidepressants but more psychotherapy compared to the ECT and AP cohorts.Name of Sponsoring Organization(s): Janssen Scientific Affairs, LLC