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SPRAVATO® (esketamine)
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Comparison of SPRAVATO to Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS)
Last Updated: 06/20/2024
SUMMARY
- Comparison of SPRAVATO to ECT has not been studied.
- In a multicenter, observational, retrospective study of 59 patients with treatment-resistant depression (TRD), the efficacy and safety of accelerated repetitive TMS (arTMS) was evaluated in comparison to SPRAVATO.1
- A greater Montgomery and Åsberg Depression Rating Scale (MADRS) score decrease was observed in the arTMS group after 1 month of treatment (P=0.048) but not after 3 months. Eight patients (26.66%) in the arTMS group versus 24 (82.75%) patients in the SPRAVATO group experienced treatment-related adverse events (TrAEs).
Clinical Data
Pettorruso et al (2023)1 conducted a multicenter, observational, retrospective study in 59 patients with TRD evaluating the efficacy and safety of arTMS compared to SPRAVATO in reducing depressive symptoms. Patients were assigned treatment with arTMS (N=30) or SPRAVATO (N=29) based on clinicians’ discretion. MADRS total score was assessed at baseline (T0), one month (T1), and three months (T2) after treatment initiation. A greater MADRS score decrease was observed in the arTMS group at T1 (P=0.048) but not at T2 (See table: MADRS Total Score at Baseline, 1, and 3 months). Response rates (≥50% decrease of MADRS total score) were higher in arTMS than SPRAVATO at T1 (p=0.008). Remission rates (MADRS total score <10) between groups were not significant.1
| MADRS | arTMS (n=30) | SPRAVATO (n=29) | Univariate Statistics |
|---|---|---|---|
| Baseline | 32.57 ± 6.83 | 35.41 ± 8.33 | t57 = -1.439, P = 0.156 |
| 1 month | 17.83 ± 8.26 | 23.45 ± 8.95 | t57 = -2.505, P = 0.015 |
| 3 months | 15.87 ± 9.67 | 15.72 ± 9.43 | t57 = 0.057, P = 0.955 |
| MADRS, Montgomery and Åsberg Depression Rating Scale; arTMS, accelerated repetitive TMS | |||
Eight patients (26.66%) in the arTMS group versus 24 (82.75%) patients in the SPRAVATO group experienced TrAEs. The most common TrAEs in the arTMS group were transient post-stimulation headache (13.3%) and scalp discomfort at the stimulation site (10%). One patient experienced agitation during the stimulation session. The most common TrAEs in the SPRAVATO group were temporary sedation (55.2%), transient dissociative symptoms (34.5%), short-lived hypertension (10%), and brief agitation (6.9%). Limitations of the study include lack of treatment randomization, unblinded assessors, and limited sample size.1
Literature Search
A literature search of MEDLINE®
References
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