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Download fileIntranasal esketamine in treatment-resistant depression: a profile of its use
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posted on 2019-10-02, 17:46 authored by Lesley J. ScottCompliance with ethical standards
Funding: The preparation of this review was not supported by any external funding.
Conflicts of interest: Lesley Scott is an employee of Adis International Ltd./Springer Nature, is responsible for the article content and declares no conflicts of interest.Enhanced material for this Adis Drug Q&A can be found here
Abstract
Intranasal
esketamine (Spravato™), the S-enantiomer
of ketamine, targets the glutamatergic system via non-competitive antagonism of the N-methyl-D-aspartate
receptor, thereby providing a novel approach to traditional antidepressants that target
modulation of the monoaminergic system. In conjunction with an oral antidepressant (OAD),
intranasal esketamine is approved in the USA for use in adult patients with treatment-resistant
depression (TRD). Given its novel mechanism and rapid onset of action,
convenient weekly or once every 2 weeks maintenance regimen, and the current
paucity of approved pharmacotherapy options for TRD, esketamine nasal spray in conjunction with an OAD provides an
important treatment option for this difficult-to-treat high-risk patient
population. In pivotal clinical trials in adult patients with TRD, flexible-dose
intranasal esketamine in conjunction with a newly initiated OAD provided rapid
and sustained improvements in depression symptoms, and had a manageable
tolerability and safety profile. Further long-term clinical experience is
required to fully define the potential benefits and risks of esketamine therapy
in combination with an OAD in TRD.
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