Esketamine in patient with treatment resistant depression: Outcome of the temporary authorization for use programme in France

Introduction

Esketamine nasal spray has been developed for patients with treatment resistant depression.

Objectives

A cohort Temporary Authorization for Use (ATUc) allowed to collect for a 6-month period the first data in real life

Methods

On 02/08/2019 the French National Agency for Medicines and Health Product Safety granted an early access program for Esketamine nasal spray framed by a specific protocol for patients without therapeutic alternatives. Each treatment request was approved based on inclusion and exclusion criteria. Clinical evolution, treatment management and safety were then spontaneously reported by psychiatrists.

Results

From 09/23/2019 to 03/25/2020, 66 patients were treated. The median age was 53 years and 41 (62.1%) were females. At treatment request, 52 patients (79%), presented a severe current depressive episode based on clinical judgment. The median duration of the disease was 12.2 years and the current episode was 2.6 years. Since the beginning of the current depressive episode, all patients (66) were prescribed ≥2 antidepressants (mean 4.2). Esketamine was initiated in a complete hospitalization setting in 27 patients (55.1%) and in day hospitalization in 22 patients (44.9%).Safety profile was consistent with the one described during clinical study. The most frequently adverse events reported (>10%) were dizziness, sedation, sleepiness, anxiety and dissociation. Most of them appeared after treatment administration and were transient.

Conclusions

ATUc ended on 12/18/2019 after Marketing Authorization granted by European Medicines Agency. Data reported by French psychiatrists are the first collected in this specific population and provide descriptive information on patient characteristics, burden of disease; Esketamine management and practical use at hospital level

Disclosure

Data analysis performed by RCTs and poster conception coordinated by Medergy and funded by Janssen

[Association between the violence in the community and the aggressive behaviors of psychotics during their hospitalizations]

BACKGROUND

Violence is a common issue in psychiatry and has multiple determiners. The aim of this study is to assess the psychotic inpatients' violence in association with the violence of the neighborhood from which the patients are drawn and to estimate the impact of this environmental factor with regard to other factors.

METHOD

A prospective multicenter study was led in nine French cities. Eligible patients were psychotic involuntary patients hospitalized in the cities' psychiatric wards. During their treatments, any kind of aggressive behavior by the patients has been reported by the Overt Aggression Scale (OAS).

RESULTS

From June 2010 to May 2011, 95 patients have been included. Seventy-nine per cent of the patients were violent during their hospitalizations. In a bivariate analysis, inpatient violence was significantly associated with different factors: male gender, patient violence history, substance abuse, manic or mixed disorder, the symptoms severity measured by the BPRS, the insight degree and the city crime rate. In a multivariate analysis, the only significant factors associated with the patients' violence were substance abuse, the symptoms severity and the crime rates from the different patients' cities.

CONCLUSION

These results suggest that violence within the psychotic patients' neighborhood could represent a risk of violence during their treatments.

Étude rétrospective sur l’efficacité et la tolérance à long terme de la clozapine sur les troubles du comportement dans les troubles du spectre autistique

Les troubles du spectre autistique (TSA) sont des troubles neuro-développementaux invalidants avec une grande hétérogénéité clinique. Beaucoup de patients avec un TSA présentent des troubles du comportement avec agressivité , ce qui perturbe leur socialisation, leurs apprentissages, leur maintien en établissement spécialisé et plus généralement, leur qualité de vie . Ces comportements-défis sont donc une cible thérapeutique privilégiée pour les praticiens. Parmi ces thérapeutiques, la clozapine a été utilisée avec succès pour atténuer les troubles du comportement, à court terme, chez les autistes âgés d’au moins 16 ans . L’objectif de ce travail est d’évaluer sur du plus long terme l’efficacité et la tolérance de la clozapine. Une étude rétrospective sur 14 patients a été menée en considérant 3 périodes (4 à 6 mois avant l’instauration du traitement, 4 à 6 mois après et le mois de novembre 2014, soit jusqu’à 5 ans après mise en place du traitement). Le critère de jugement principal était le nombre de jours par mois avec au moins un trouble du comportement, selon les critères du DC-LD (Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD, 2001). Avant l’introduction de la clozapine, la proportion moyenne des jours « avec agressivité » était de 13 jours ± 11,6, soit 43,3 %. Lors de l’évaluation de novembre 2014, la proportion moyenne des jours « avec agressivité » était de 5,67 jours ± 11,4, soit 18,9 %. Ainsi, à long terme de l’instauration de la clozapine, on observe une diminution de plus de 50 % de l’agressivité totale (56 %). Aucun effet secondaire grave, mettant en jeu le pronostic vital, n’a été constaté. Les données de notre étude suggèrent que la clozapine permettrait une réduction des troubles du comportement avec agressivité des personnes avec TSA, et cela même au long terme, avec une bonne tolérance.