Real-world esketamine nasal spray treatment duration and dosing in patients with treatment resistant depression: findings from ECHO, a non-interventional study

Introduction

Esketamine nasal spray (NS), in combination with an SSRI or SNRI, is indicated for use in adults with treatment resistant depression (TRD).[1]

Evaluating patients’ treatment patterns with esketamine NS across real-world clinical settings can facilitate improved understanding of current trends in clinical decision-making, including treatment dosing and duration. Furthermore, assessing patients’ treatment patterns is important to better understand the subsequent impacts on patient outcomes.

Aims

This analysis aimed to assess the real-world treatment patterns of patients with TRD who were initiating esketamine NS as a new antidepressive treatment regimen, including duration, dosing and frequency, and reasons for treatment discontinuation. Further details on changes in dosing and frequency over time, and the impact of treatment regimens on patient outcomes will be presented in the poster.

Methods

Esketamine CoHOrt (ECHO) was a long-term, prospective, international, non-interventional study investigating esketamine NS long-term effectiveness and safety in real-world clinical settings. Esketamine NS was prescribed per the local label, in accordance with local reimbursement criteria independent of the study.

ECHO comprised a treatment period (TP) of variable duration; the duration of esketamine NS exposure, dosing and frequency, and reasons for discontinuation are reported.

Results

In total, 570 patients from 7 countries (Germany, Italy, Israel, Belgium, Spain, Sweden and the Netherlands) started the TP in ECHO. The mean and median esketamine NS treatment durations were 266.5 days (~9 months) and 190 days (~6 months), respectively. Of 570 patients, 23.2% received esketamine NS for >12 months (Table).

Esketamine NS 84 mg was the most frequently administered dose in 67.4% (n=375/556) of patients, the highest dose taken in 79.3% of patients and the final dose taken in 66.8% of patients. The most common reasons for treatment discontinuation were patients no longer requiring treatment (28.9%; mainly due to depressive symptom resolution), lack of efficacy (20.4%) and patient preferences (19.1%; Table).

Conclusions

Real-world use of esketamine NS in patients with TRD was characterised by marked heterogeneity in treatment duration, reflecting individualised clinical decision-making in combination with treatment guidelines. Dose optimisation, including escalation to the highest approved dose (84 mg), was commonly employed and may be central to achieving and sustaining clinical benefit in routine practice.

Importantly, treatment discontinuation was most frequently driven by symptom resolution rather than lack of efficacy or adverse events, underscoring the clinical effectiveness of personalised esketamine NS regimens in real-world settings.

TABLE. Real-world treatment patterns of esketamine NS in ECHO

	Esketamine NS + SSRI/SNRI (N=570)
Duration of esketamine NS exposure, n (%)
<3 months	174 (30.5)
3–6 months	100 (17.5)
6–9 months	114 (20.0)
9–12 months	50 (8.8)
>12 months	132 (23.2)
Reasons for treatment discontinuation, n (%)
Patient no longer requiring treatment	165 (28.9)
Lack of efficacy	116 (20.4)
Patient preference	109 (19.1)
Other	59 (10.4)
Adverse event	47 (8.2)
Lack of compliance	6 (1.1)
Lack of tolerability	4 (0.7)
Death	3 (0.5)

NS: nasal spray; SNRI: serotonin norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor.

References

1. European Medicines Agency, 2025. SPRAVATO® (esketamine NS) Summary of Product Characteristics. Available from: https://www.ema.europa.eu/en/documents/product-information/spravato-epar-product-information_en.pdf. [Accessed: March 2026].