Barriers to Esketamine Nasal Spray Treatment Among Adults With Treatment-Resistant Depression.

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Clinical Psychiatry Pub Date : 2024-05-06 DOI:10.4088/JCP.23m15102

Kruti Joshi, Joshua N Liberman, Purva Parab, Jonathan D Darer, Lisa Harding

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引用次数: 0

Abstract

Background: Under a risk evaluation and mitigation strategy program, esketamine nasal spray CIII requires self administration at a certified treatment center. Our objective was to identify factors associated with esketamine initiation and continuation.

Methods: A retrospective observational cohort study was conducted among US adults who met treatment-resistant depression (TRD) criteria. Cases (n = 966) initiated esketamine between October 11, 2019, and February 28, 2022, and were compared to controls (n = 39,219) with TRD but no esketamine use. Outcomes included initiation, induction (8 administrations within 45 days), and interruptions (30-day treatment gap). Comorbid psychiatric conditions were identified using International Classification of Diseases, Tenth Revision, Clinical Modification, codes.

Results: Cases resided significantly closer to treatment centers (8.9 vs 20.3 miles). Compared to 0-9 miles, initiation rate decreased by 11.9%, 50.8%, 68.1%, 75.9%, and 92.8% for individuals residing 10-19, 20-29, 30-39, 40-49, and 50+ miles from a center. After adjustment, factors associated with increased likelihood of initiation were posttraumatic stress disorder, major depressive disorder with suicidal ideation, and male sex, while increasing distance, substance use disorder, Medicaid, Charlson Comorbidity Index (CCI), and older age were associated with lower likelihood. Factors associated with lower likelihood of completing induction were Medicaid, low socioeconomic status (SES), CCI, and Hispanic communities. Factors associated with increased likelihood of interruption were alcohol use disorder, distance, and minority communities, while generalized anxiety disorder and Medicaid were associated with lower likelihood.

Conclusions: Travel distance, insurance, low SES, and minority communities are potential barriers to treatment. Alternative care models may be needed to ensure adequate access to care.

J Clin Psychiatry 2024;85(2):23m15102.

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难治性抑郁症成人接受 Esketamine 鼻用喷雾剂治疗的障碍。

背景：根据一项风险评估和缓解战略计划，埃斯氯胺酮鼻喷雾剂 CIII 需要在经认证的治疗中心自行使用。我们的目的是确定与开始和继续使用埃斯氯胺酮相关的因素：我们对符合治疗耐受性抑郁症（TRD）标准的美国成年人进行了一项回顾性观察队列研究。病例（n = 966）在2019年10月11日至2022年2月28日期间开始使用埃斯卡胺，并与患有TRD但未使用埃斯卡胺的对照组（n = 39,219）进行了比较。结果包括起始、诱导（45天内8次给药）和中断（30天治疗间隙）。使用《国际疾病分类》第十版临床修正版代码确定合并精神疾病：结果：病例居住地明显更靠近治疗中心（8.9 英里对 20.3 英里）。与距离治疗中心 0-9 英里相比，居住在距离治疗中心 10-19 英里、20-29 英里、30-39 英里、40-49 英里和 50 英里以上的患者的入院率分别下降了 11.9%、50.8%、68.1%、75.9% 和 92.8%。经调整后，创伤后应激障碍、有自杀倾向的重度抑郁障碍和男性与启动可能性增加有关，而距离增加、药物使用障碍、医疗补助、查尔森综合指数（CCI）和年龄较大与启动可能性降低有关。医疗补助、社会经济地位低（SES）、CCI 和西班牙裔社区与完成诱导的可能性较低有关。与中断的可能性增加有关的因素是酒精使用障碍、距离和少数民族社区，而广泛性焦虑症和医疗补助与较低的可能性有关：结论：旅行距离、保险、社会经济地位低和少数民族社区是治疗的潜在障碍。结论：旅行距离、保险、低社会经济地位和少数族裔社区是潜在的治疗障碍，可能需要替代性治疗模式来确保充分获得治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychiatry 医学-精神病学

CiteScore

7.40

自引率

1.90%

发文量

审稿时长

3-8 weeks

期刊介绍： For over 75 years, The Journal of Clinical Psychiatry has been a leading source of peer-reviewed articles offering the latest information on mental health topics to psychiatrists and other medical professionals.The Journal of Clinical Psychiatry is the leading psychiatric resource for clinical information and covers disorders including depression, bipolar disorder, schizophrenia, anxiety, addiction, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder while exploring the newest advances in diagnosis and treatment.