The Janssen Pharmaceutical Companies of Johnson & Johnson announced that the European Commission (EC) has authorised the expanded use of SPRAVATO® (esketamine nasal spray), co-administered with oral antidepressant therapy in adults with a moderate to severe episode of MDD, as acute short term treatment, for the rapid reduction of depressive symptoms, which according to clinical judgement constitute a psychiatric emergency.
“Depression is more than just feeling sad, it’s a debilitating combination of symptoms that are different for each person and can progress to a point where patients may experience a psychiatric emergency,” said Professor Maurizio Pompili†, Director, University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome, Italy. “Many antidepressants are effective in treating depressive symptomatology but do not provide rapid relief for patients and can take weeks to achieve their full effect. The fast-acting nature of esketamine nasal spray in these patients may address a key unmet need within this population.”
The EC authorisation of esketamine nasal spray is based on data from the Phase 3 double-blind, randomised, placebo controlled, multicentre ASPIRE I & II clinical studies conducted globally. These studies compared the efficacy and safety of esketamine nasal spray in combination with comprehensive standard of care (SOC) against placebo nasal spray in combination with comprehensive SOC in adult patients with moderate to severe MDD and current/active suicidal ideation with intent. The comprehensive SOC included initial psychiatric hospitalisation and newly initiated or optimised oral antidepressant therapy, which was determined by the treating physician based on clinical judgement and practice guidelines, for the duration of the studies. The comprehensive SOC was enhanced by twice-weekly visits with extensive clinical contact, and concomitant use of benzodiazepines was permitted during the study.
Within each study, patients treated with esketamine nasal spray accompanied by comprehensive SOC had a statistically significant and clinically meaningful reduction in depressive symptoms (reduction from baseline Montgomery-Åsberg Depression Rating Scale [MADRS]* total score) at 24 hours after receiving the first dose compared to placebo nasal spray in combination with comprehensive SOC (p=0.006). The benefit of esketamine nasal spray plus comprehensive SOC on symptoms of MDD was apparent as early as 4 hours after the first dose. The effectiveness of esketamine nasal spray in preventing suicide or in reducing suicidal ideation or behaviour was not demonstrated.
The safety profile for esketamine nasal spray in this patient population was consistent with previous studies in adults with treatment-resistant major depressive disorder (TRD).1,8 The most common treatment-emergent adverse events (≥20%) observed in the esketamine nasal spray plus comprehensive SOC group versus the placebo nasal spray plus comprehensive SOC group during the double-blind phase were dizziness (38.3% vs 13.8%), dissociation (33.9% vs 5.8%), nausea (26.9% vs 13.8%), somnolence (20.7% vs 10.2%), and headache (20.3% vs 20.4%), respectively.
“At Janssen, we are committed to reducing the devastating burden caused by serious mental illnesses and this further authorisation of esketamine nasal spray by the European Commission is a key milestone in our ongoing work towards this goal,” said Bill Martin, Ph.D., Global Therapeutic Area Head, Neuroscience, Janssen Research & Development, LLC. “Esketamine nasal spray offers adults with MDD who are in need of urgent relief, an effective treatment to reduce their debilitating depressive symptoms. This authorisation provides a new and innovative treatment option to this vulnerable population.”
This EC authorisation is valid in all 27 member states of the European Union as well as the EEA countries (Norway, Iceland and Liechtenstein), and Northern Ireland and Great Britain following the additional step of validation and processing of the baseline submission required following the end of the transition period post-Brexit. Esketamine nasal spray is already authorised by the EC for use in combination with a selective serotonin reuptake inhibitor (SSRI) or a serotonin and norepinephrine reuptake inhibitor (SNRI), in adult patients with treatment-resistant major depressive disorder (TRD).