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Karger Publishers, Psychotherapy and Psychosomatics, 1(90), p. 41-48, 2020

DOI: 10.1159/000510703

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Post-Marketing Safety Concerns with Esketamine: A Disproportionality Analysis of Spontaneous Reports Submitted to the FDA Adverse Event Reporting System

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

<b><i>Introduction:</i></b> Esketamine nasal spray received approval for treatment-resistant depression in March 2019. <b><i>Objective:</i></b> Using the FDA Adverse Event Reporting System (FAERS) database (March 2019–March 2020), we analysed esketamine-related adverse events (AEs) to detect and characterize relevant safety signals. <b><i>Methods:</i></b> We used the consolidated case/non-case approach to estimate the reporting odds ratio (ROR) and information component (IC) with relevant confidence intervals (95% CI) for esketamine-related AEs with ≥4 counts. Comparisons between serious and non-serious AEs were performed using non-parametric tests. <b><i>Results:</i></b> The FAERS database contained 962 cases of esketamine-related AEs, with signals detected for several AEs, such as dissociation (ROR = 1,612.64, 95% CI = 1,354.63, 1,919.79; IC = 8.19, 95% CI = 7.96, 8.35), sedation (ROR = 238.46, 95% CI = 202.98, 280.15; IC = 7, 95% CI = 6.75, 7.18), feeling drunk (ROR = 96.17, 95% CI = 61.42, 150.57; IC = 4.84, 95% CI = 4.09, 5.36), suicidal ideation (ROR = 24.03, 95% CI = 18.72, 30.84; IC = 4.31, 95% CI = 3.9, 4.61), and completed suicide (ROR = 5.75, 95% CI = 3.18, 10.41; IC = 2.25, 95% CI = 1.23, 2.94). Signals for suicidal and self-injurious ideation, but not suicide attempt and completed suicide, remained when comparing esketamine to venlafaxine. Females and patients receiving antidepressant polypharmacy, co-medication with mood stabilizers, antipsychotics, benzodiazepines, or somatic medications were more likely to suffer from serious versus non-serious AEs (χ<sup>2</sup> = 125.29, <i>p</i> &#x3c; 0.001, χ<sup>2</sup> = 9.08, <i>p</i> = 0.003, χ<sup>2</sup> = 8.14, <i>p</i> = 0.004, χ<sup>2</sup> = 19.48, <i>p</i> &#x3c; 0.001, χ<sup>2</sup> = 25.62, <i>p</i> &#x3c; 0.001, and χ<sup>2</sup> = 16.79, <i>p</i> &#x3c; 0.001, respectively). <b><i>Conclusions:</i></b> Esketamine may carry a clear potential for serious AEs, which deserves urgent clarification by means of further prospective studies.