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Janssen responds to NICE draft guidance not to recommend SPRAVATO®▼ (esketamine) nasal spray for treatment-resistant major depressive disorder

The Janssen Pharmaceutical Companies of Johnson & Johnson is disappointed with the National Institute for Health and Care Excellence (NICE) second draft guidance published today, that does not recommend SPRAVATO® (esketamine) nasal spray in combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI), for adults living with treatment-resistant major depressive disorder (MDD), who have not responded to at least two different treatments with antidepressants in the current moderate to severe depressive episode.[i]


“It is a real shame that this treatment will now need to go through a third appraisal committee and is extremely frustrating for clinicians and for patients living with treatment-resistant major depressive disorder who are in desperate need of an alternative treatment option,” commented Amanda Cunnington, Director of Health Economics, Market Access & Reimbursement (HEMAR) and Advocacy, Janssen-Cilag Limited. “It is important that Janssen and NICE work together along with other stakeholders to make sure that innovative treatments in mental health, such as esketamine nasal spray, are able to navigate the NICE appraisal process and, once approved, be used in clinical practice. There are real challenges in the way mental healthcare is considered that limits access and uptake of innovation, which contributes to the disparity between treatments for physical and mental health.”


NICE has recognised the negative impact treatment-resistant depression has on patients, their families and carers, and the unmet need for new effective treatment options. Depression is the leading cause of disability worldwide and is one of the conditions most frequently associated with suicide.[ii],[iii] Major depressive disorder is a serious disease that causes a significant, negative impact on the way people think, feel and act.4 Symptoms and severity vary by person and may include: persistent feelings of sadness; hopelessness or tension; changes in sleep or appetite; difficulty concentrating or performing activities of daily living; lack of interest; and/or thoughts of harming themselves.[iv],[v]


Janssen believes that, based on the evidence submitted, esketamine nasal spray is a cost-effective use of National Health Service (NHS) resources. Janssen is seeking to address NICE’s concerns and is confident that based on further technical responses and additional discussions with NICE, a route can be found for esketamine nasal spray to be made available for eligible patients.


The consultation on the second draft guidance is open until 25 September 2020. Final guidance is expected later this year.


[i] NICE. Appraisal consultation document. Esketamine for treating treatment-resistant depression. Available at: Accessed September 2020.

[ii] World Health Organization. Depression Factsheet. Available at: Accessed September 2020.

[iii] Brådvik L. Suicide Risk and Mental Disorders. Int J Environ Res Public Health. 2018;15(9):2028. doi:10.3390/ijerph15092028

[iv] American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). 2013 Arlington, VA: American Psychiatric Publishing.

[v] National Institute for Health and Care Excellence. Depression in adults: treatment and management. Full guideline (Consultation draft May 2018). Available at Accessed September 2020

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Last Updated: 03-Sep-2020