Assessment of patient-reported depression severity in subpopulation of ESCAPE-TRD study: esketamine nasal spray versus quetiapine extended release for treatment-resistant depression
Current Medical Research and Opinion, 2025
Objective
ESCAPE-TRD, a randomized phase 3b trial, compares the efficacy and safety of esketamine nasal spray (NS) and extended-release (XR) quetiapine, both in combination with ongoing oral antidepressant (OAD) treatment, among individuals with treatment-resistant depression (TRD). Although prior analyses used the clinician-rated MADRS, the comparative efficacy of esketamine NS vs. quetiapine XR using a patient-reported instrument to assess TRD severity among a subgroup treated according to US label is unknown.
Methods
ESCAPE-TRD data were evaluated using the patient-rated Patient Health Questionnaire-9 (PHQ-9) instrument for individuals receiving treatment consistent with US prescribing information (NCT04338321). The main outcome was remission at weeks 8 and 32. Additional outcomes included response, time to first remission, time to first response, time to confirmed remission, time to confirmed response, and change in PHQ-9 score from baseline.
Results
A significantly higher proportion of individuals in the esketamine NS group than in the quetiapine XR group achieved remission and response at week 8 (remission: 19.3% vs. 12.2%; RD [95% CI]: 7.1% [1.5%, 12.8%]; p = 0.013; response: 49.4% vs. 32.8%, RD [95% CI]:16.6% [9.0%, 24.1%]; p < 0.001). At 32 weeks, a significantly higher proportion of individuals in the esketamine NS group achieved remission and response compared to the quetiapine XR group (remission: 34.8% vs. 18.1%, RD [95% CI]: 16.7% [9.9%, 23.4%]; p < 0.001; response: 58.9% vs. 40.3%, RD [95% CI]:18.5% [10.9%, 26.2%]; p < 0.001).
Conclusion
Using patient-reported PHQ-9 scoring to evaluate ESCAPE-TRD results, esketamine NS produced superior short- and long-term efficacy vs. quetiapine XR among individuals with TRD treated according to US label.
Authors
Clemens K, Rive B, Joshi K, Thilakarathne P, Kirson N, Desai U, Doran J, Eid D, Qu A, Godinov Y