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Williamson DJ, Gogate JP, Kern Sliwa JK, Manera LS, Preskorn SH, Winokur A, Starr HL, Daly EJ. Longitudinal Course of Adverse Events With Esketamine Nasal Spray: A Post Hoc Analysis of Pooled Data From Phase 3 Trials in Patients With Treatment-Resistant Depression. J Clin Psychiatry 2022; 83. [PMID: 36149841 DOI: 10.4088/jcp.21m14318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: To describe the tolerability of esketamine nasal spray based on the adverse event profile observed during treatment sessions occurring early and later over the course of treatment. Methods: In 2 long-term, phase 3 studies (NCT02493868, October 1, 2015-February 16, 2018; NCT02497287, September 30, 2015-October 28, 2017), patients with treatment-resistant major depressive disorder (per DSM-5) and nonresponse to ≥ 2 oral antidepressants received esketamine nasal spray (56 or 84 mg) twice weekly during a 4-week induction phase, weekly for weeks 5-8, and weekly or every 2 weeks thereafter as maintenance treatment, in conjunction with a new oral antidepressant. A post hoc analysis using descriptive statistics evaluated occurrence (incidence, frequency, severity) and recurrence (incidence and severity) of events of specific interest. Results: In patients treated with esketamine nasal spray plus a newly initiated oral antidepressant (n = 928), spontaneously reported adverse events of dizziness, nausea, sedation, vertigo, and increased blood pressure were more likely to recur after the first week of treatment if they occurred more frequently (twice > once > none) during the first week. The same pattern was observed when these events were assessed by structured instruments. Incidences of dizziness, dissociation, increased blood pressure, nausea, vertigo, and sedation were highest in week 1 of treatment (20.6%, 16.7%, 4.3%, 14.0%, 12.1%, and 3.8%, respectively) and decreased thereafter. Initial occurrences and subsequent recurrences of events were mostly mild or moderate in severity. Conclusions: Adverse events during treatment with esketamine nasal spray plus an oral antidepressant generally become less frequent with ongoing treatment, and the majority are mild or moderate in severity. Trial Registration: ClinicalTrials.gov identifiers: NCT02493868; NCT02497287.
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Affiliation(s)
- David J Williamson
- Field-Based Medical Affairs, Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Drs Williamson and Daly and Mr Manera were affiliated with Janssen Scientific Affairs, LLC, at the time the trial was conducted.,Corresponding author: David J. Williamson, PhD, University of South Alabama College of Medicine, 2450 Old Shell Rd, Ste A, Mobile, AL 36607
| | - Jagadish P Gogate
- Statistics and Decision Sciences, Janssen Research & Development, LLC, Titusville, New Jersey
| | - Jennifer K Kern Sliwa
- Neuroscience Medical Information, Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Lewis S Manera
- Janssen Medical Information, Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Drs Williamson and Daly and Mr Manera were affiliated with Janssen Scientific Affairs, LLC, at the time the trial was conducted
| | - Sheldon H Preskorn
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, Kansas
| | - Andrew Winokur
- Department of Psychiatry, UConn Health, Farmington, Connecticut
| | - H Lynn Starr
- Clinical Development, Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Ella J Daly
- Field-Based Medical Affairs, Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Drs Williamson and Daly and Mr Manera were affiliated with Janssen Scientific Affairs, LLC, at the time the trial was conducted
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Bell Lynum KS, Henderson DC, Wright HJ, Gogate JP, Kim E. Treatment Effect With Paliperidone Palmitate Compared With Oral Antipsychotics in Black/African American Patients With Schizophrenia and a History of Criminal Justice System Involvement: A Post Hoc Analysis of the PRIDE Study. J Clin Psychiatry 2021; 82. [PMID: 33988924 DOI: 10.4088/jcp.20m13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the efficacy and safety of paliperidone palmitate once-monthly (PP1M) versus oral antipsychotics (OAPs) in Black/African American patients with schizophrenia and a history of criminal justice system involvement. METHODS This was a post hoc analysis of a 15-month prospective, randomized, open-label, parallel-group, multicenter US study conducted from May 2010 to December 2013 that examined a subpopulation of Black/African American patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The primary objective was to compare time to first treatment failure in patients treated with PP1M versus OAPs. Secondary objectives were to compare time to first institutionalization (psychiatric hospitalization or arrest/incarceration) and mean number of treatment failure events and institutionalizations over 15 months in PP1M-treated and OAP-treated patients. RESULTS The intention-to-treat population included 275 Black/African American patients (PP1M, n = 145; OAPs, n = 130). Median time to first treatment failure was not reached for PP1M-treated patients and was 270 days for OAP-treated patients; hazard ratio (HR) was 1.39 (95% CI, 0.97-1.99; P = .075). Median time to first institutionalization was not reached for PP1M-treated patients and was 304 days for OAP-treated patients; HR was 1.49 (95% CI, 1.01-2.19; P = .043). Mean numbers of treatment failure events and institutionalizations were lower with PP1M than OAPs. The safety profile of PP1M was consistent with that of previous PP1M studies. CONCLUSIONS In a Black/African American subpopulation of patients with schizophrenia and prior criminal justice system involvement, PP1M reduced the number of treatment failures, thereby reducing the number of psychiatric hospitalizations and/or arrests/incarcerations compared with daily OAPs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01157351.
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Affiliation(s)
- Karimah S Bell Lynum
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Corresponding author: Karimah S. Bell Lynum, PharmD, MBA, BCPP, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560
| | - David C Henderson
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | | | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Affiliation at the time the analysis was conducted
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