Treatment Patterns and Persistence Among Patients with Treatment-Resistant Depression Initiated on Esketamine Nasal Spray

Abstract: BACKGROUND: Durability of esketamine clinical benefits for treatment resistant depression (TRD) may correlate with treatment sessions completed and therapy persistence. Understanding esketamine real-world use patterns and persistence is necessary to contextualize therapy performance. METHODS: Adults with TRD initiated on esketamine (index date) with ≥12 months of continuous insurance eligibility preceding index date (baseline) and Patient Health Questionnaire (PHQ-9) scores available were identified using Komodo Research Database closed claims (01/2016-06/2023). Esketamine use was described in the follow-up period, which spanned the index date to end of continuous insurance eligibility or data. Persistent time on esketamine (no gap >60 days between sessions) was estimated using Kaplan-Meier analysis. RESULTS: 103 patients were selected (mean age: 41.5 years, 65.0% females, 68.9% had commercial insurance, 20.4% Medicaid and 7.8% Medicare Advantage). At baseline, 66.0% used ≥3 unique antidepressants, 46.6% used antipsychotics, and the mean PHQ-9 score was 15.1 (moderately severe depression). During the follow-up period (mean: 15.7 months), patients had a mean (median) of 21.7 (14.0) esketamine sessions; among 70.9% who completed induction (≥8 sessions), half completed within 64.0 days (per label, 28 days); 61.2% completed ≥12 sessions. Probabilities of esketamine persistence 6 and 12 months post index were 61.7% (95% confidence interval [CI]: 50.7-70.9) and 32.0% (95% CI: 21.9-42.5), respectively. CONCLUSIONS: Most patients with TRD initiating esketamine complete induction, however, largely exceeding recommended per-label timeframes. Additionally, there is a potential for improving esketamine persistence. Collaboration between payers, providers, and patients is necessary to improve esketamine treatment patterns and maximize its clinical benefits.Short Description: Prior research highlighted potential for improving esketamine real-world use patterns in treatment-resistant depression (TRD). In this health insurance claims study, patients completed a mean of 21.7 esketamine sessions; among 70.9% who completed induction (≥8 sessions), half did so within 64.0 days (per label, 28 days). Probabilities of esketamine persistence at 6 and 12 months post index were 61.7% and 32.0%, respectively. Potential to improve esketamine treatment patterns exists to maximize its clinical benefits.Name of Sponsoring Organization(s): Johnson & Johnson Innovative Medicine