Budapest, Hungary — A single dose of intravenous esketamine throughout supply or caesarean part seems to scale back the danger for postpartum despair (PPD) by greater than 50% within the first 6 weeks, a brand new meta-analysis steered. Nevertheless, the long-term security and efficacy of the drug are nonetheless unclear.
Research investigator Angelina Kozhokar, MD, Division of Medication, Universitat Internacional de Catalunya, Barcelona, Sant Cugat del Vallès, Spain, instructed Medscape Medical Information she was “shocked” by the dimensions of the PPD danger discount related to the drug.
Nevertheless, she added, “it is vital to think about that preliminary research on numerous drugs used for postpartum despair have additionally proven very large impact sizes.”
Kozhokar believes that as extra research inspecting esketamine for PPD are carried out, “we’ll see extra definitive impact sizes, and the security profile for this new remedy” will grow to be clearer.
The findings have been introduced right here on the European Psychiatric Affiliation 2024 Congress.
Important Discount
As beforehand reported by Medscape Medical Information, intranasal esketamine (Spravato, Janssen) was proven to be superior to extended-release quetiapine (Seroquel, AstraZeneca), an atypical antipsychotic, for treatment-resistant despair.
With as much as 13% of girls experiencing PPD within the perinatal interval, the researchers sought to look at the impression of esketamine administered prophylactically throughout labor or caesarean part on the incidence of the dysfunction.
They searched the PubMed, Scopus, and Google Scholar databases for randomized managed trials inspecting the efficacy of esketamine and screened for PPD utilizing the Edinburgh Postpartum Despair Scale (EPDS).
Whereas the intranasal spray is the one type of esketamine accredited by the US Meals and Drug Administration, an injectable answer can be out there. The researchers recognized seven eligible trials that included a complete of 1287 ladies. Of those contributors, 635 (49.3%) obtained esketamine. Esketamine was delivered as both patient-controlled intravenous analgesia or a single intravenous dose throughout supply or caesarian part.
Throughout the seven trials, esketamine was related to a big discount in PPD at 1 week after supply at a danger ratio vs placebo of 0.459 (P < .05). At 6 weeks, the discount in PPD incidence was maintained, at a danger ratio of 0.470 (P < .01).
Nevertheless, Kozhokar identified that the EPDS is a subjective measure of PPD, and the research used completely different cutoff scores for despair, starting from 9 to 13 factors.
Unanswered Questions
She additionally cautioned that the hostile results of esketamine on maternal and neonatal well being should be assessed, in addition to the long-term value/profit ratio of prophylactic remedy.
All seven research included within the meta-analysis have been carried out in China, which limits the generalizability of the findings.
“I suppose they have been faster to get to the subject than the remainder of the world,” Kozhokar stated, whereas additionally suggesting that, probably, “we’re extra regulated right here in Europe.”
She identified that there’s “an vital security concern about using drugs comparable to ketamine and esketamine” by way of the potential for dependancy and the impact on infants over the long run, which is at present unknown.
Session chair Linda Rubene, MD, a psychiatrist within the Division of Psychiatry and Narcology at Rīga Stradiņš College, Riga, Latvia, welcomed the examine.
“If we had extra choices to deal with postpartum despair and to deal with despair throughout being pregnant, it could be an ideal enchancment,” she stated.
Nevertheless, she famous, as a result of there aren’t any long-term consequence knowledge for esketamine in PPD, extra examine is required. It’s potential, stated Rubene, that esketamine might not work for all ladies.
The investigators and Rubene reported no related monetary disclosures.