The article "Safety and Tolerability of Esketamine versus Quetiapine Extended Release in Adults with TRD" compares the adverse effects and overall safety of esketamine nasal spray (NS) and quetiapine extended release (XR) in patients with treatment-resistant depression (TRD). Conducted as part of the ESCAPE-TRD trial, the study involved 336 patients randomized to esketamine NS and 340 to quetiapine XR, with both treatments used alongside a selective serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor.

Key findings showed that TEAEs were more frequent with esketamine NS (91.9%) compared to quetiapine XR (78.0%), but the adverse events associated with esketamine were typically mild to moderate and resolved on the same day in 92.0% of cases, compared to 12.1% for quetiapine XR. Furthermore, fewer patients discontinued esketamine NS (4.2%) due to TEAEs compared to quetiapine XR (11.0%). Patients on esketamine NS experienced fewer days with TEAEs (median of 11.9%) compared to those on quetiapine XR (21.3%).

The study concluded that esketamine NS demonstrated greater efficacy and a more favorable tolerability profile than quetiapine XR. The safety data were consistent with established profiles, with no new safety signals identified. Future research directions include further investigation into the long-term safety and efficacy of esketamine NS, its use in combination therapies, and its impact on patient quality of life. .