Wei Zheng4, Dong-Bin Cai2, Ying-Qiang Xiang3, Wei Zheng4, Wen-Long Jiang5, Kang Sim6, Gabor S Ungvari7, Xiong Huang1, Xing-Xiao Huang1, Yu-Ping Ning8, Yu-Tao Xiang9. 1. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. 2. Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China. 3. Mental Health Prevention Hospital of Haidian District in Beijing, Beijing, China. 4. Xiamen Xian Yue Hospital, Xiamen, China. 5. The Third People's Hospital of Daqing, Daqing, China. 6. Institute of Mental Health, Buangkok Green Medical Park, Buangkok, Singapore. 7. University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia. 8. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China. Electronic address: ningjeny@126.com. 9. Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau; Center for Cognition and Brain Sciences, University of Macau, Taipa, Macau. Electronic address: xyutly@gmail.com.
Abstract
OBJECTIVES: This is a meta-analysis of randomized double-blind controlled-placebo trials (RCTs) examining the effectiveness, tolerability, and safety of intranasal esketamine in treating major depressive disorder (MDD). METHODS: Standardized mean difference (SMD), risk ratio (RR) and their 95% confidence intervals (CIs) were calculated using RevMan version 5.3. RESULTS: Four RCTs with 7 active arms covering 708 patients with MDD on intranasal esketamine (n = 419) and placebo (n = 289) were included. Compared with placebo, adjunctive intranasal esketamine was associated with significantly greater study-defined response (RR=1.39, 95%CI: 1.18 to 1.64, P<0.0001) and remission (RR=1.42, 95%CI: 1.17 to 1.72, P = 0.0004) at endpoint assessment. Intranasal esketamine had greater study-defined response starting at 2 h (RR= 2.77, 95%CI: 1.62 to 4.76, P = 0.0002), peaking at 24 h (RR=5.42, 95%CI: 1.38 to 21.20, P = 0.02), and at least lasting for 28 days (RR=1.36, 95%CI: 1.16 to 1.58, P = 0.0001). Similarly, intranasal esketamine had significantly greater study-defined remission starting at 2 h (RR=7.71, 95%CI: 2.16 to 27.55, P = 0.002), peaking at 24 h (RR=6.87, 95%CI: 1.55 to 30.35, P = 0.01), and lasting for 28 days (RR=1.38, 95%CI: 1.11 to 1.72, P = 0.004). Intranasal esketamine had a significantly higher rate of discontinuation due to intolerability (RR=3.50, 95%CI: 1.38 to 8.86, P = 0.008). Discontinuation due to any reasons and inefficacy were similar between the two groups. CONCLUSION: Intranasal esketamine appears to have an ultra-rapid antidepressant effect for MDD, at least lasting for 28 days. The long-term therapeutic effect and safety of intranasal esketamine need to be further examined in large-scale RCTs.
OBJECTIVES: This is a meta-analysis of randomized double-blind controlled-placebo trials (RCTs) examining the effectiveness, tolerability, and safety of intranasal esketamine in treating major depressive disorder (MDD). METHODS: Standardized mean difference (SMD), risk ratio (RR) and their 95% confidence intervals (CIs) were calculated using RevMan version 5.3. RESULTS: Four RCTs with 7 active arms covering 708 patients with MDD on intranasal esketamine (n = 419) and placebo (n = 289) were included. Compared with placebo, adjunctive intranasal esketamine was associated with significantly greater study-defined response (RR=1.39, 95%CI: 1.18 to 1.64, P<0.0001) and remission (RR=1.42, 95%CI: 1.17 to 1.72, P = 0.0004) at endpoint assessment. Intranasal esketamine had greater study-defined response starting at 2 h (RR= 2.77, 95%CI: 1.62 to 4.76, P = 0.0002), peaking at 24 h (RR=5.42, 95%CI: 1.38 to 21.20, P = 0.02), and at least lasting for 28 days (RR=1.36, 95%CI: 1.16 to 1.58, P = 0.0001). Similarly, intranasal esketamine had significantly greater study-defined remission starting at 2 h (RR=7.71, 95%CI: 2.16 to 27.55, P = 0.002), peaking at 24 h (RR=6.87, 95%CI: 1.55 to 30.35, P = 0.01), and lasting for 28 days (RR=1.38, 95%CI: 1.11 to 1.72, P = 0.004). Intranasal esketamine had a significantly higher rate of discontinuation due to intolerability (RR=3.50, 95%CI: 1.38 to 8.86, P = 0.008). Discontinuation due to any reasons and inefficacy were similar between the two groups. CONCLUSION: Intranasal esketamine appears to have an ultra-rapid antidepressant effect for MDD, at least lasting for 28 days. The long-term therapeutic effect and safety of intranasal esketamine need to be further examined in large-scale RCTs.
Authors: Gustavo C Leal; Igor D Bandeira; Fernanda S Correia-Melo; Manuela Telles; Rodrigo P Mello; Flavia Vieira; Cassio S Lima; Ana Paula Jesus-Nunes; Lívia N F Guerreiro-Costa; Roberta F Marback; Ana Teresa Caliman-Fontes; Breno L S Marques; Marília L O Bezerra; Alberto L Dias-Neto; Samantha S Silva; Aline S Sampaio; Gerard Sanacora; Gustavo Turecki; Colleen Loo; Acioly L T Lacerda; Lucas C Quarantini Journal: Eur Arch Psychiatry Clin Neurosci Date: 2020-02-20 Impact factor: 5.270
Authors: Hewa Artin; Sean Bentley; Eamonn Mehaffey; Fred X Liu; Kevin Sojourner; Andrew W Bismark; David Printz; Ellen E Lee; Brian Martis; Sharon De Peralta; Dewleen G Baker; Jyoti Mishra; Dhakshin Ramanathan Journal: EClinicalMedicine Date: 2022-05-06
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