Johnson & Johnson’s esketamine nasal spray Spravato didn’t look like a sure-fire win after it hit the market in 2019. Despite blazing a new trail as the first psychedelic-based treatment to score an FDA nod, the depression medication got off to a sluggish start, and the company didn’t even report sales figures for the first few years. Times have changed.
J&J reported that Spravato reached worldwide sales of $780 million in the first nine months of 2024 — 62% higher than the same period the year before. The story was the same in 2023 when Spravato sales spiked 89% in the first three quarters compared to 2022.
What’s been driving that growth?
Following the initial launch, critics took aim at Spravato’s efficacy and pricing, and the treatment was ultimately rejected for coverage in the U.K.
And then pandemic-related challenges further stymied the launch by complicating arrangements for the drug’s necessary medical supervision. After in-person doctor visits were once again the norm, J&J began to market the drug more heavily and raise its profile.
“We always knew it would take time to see significant uptake — new models of care always do — but the overwhelming patient need continues to drive treatment center expansion,” Bill Martin, global neuroscience therapeutic area head at Johnson & Johnson Innovative Medicine, said in an email.
Martin pointed to the accumulation of safety and efficacy data over time as another contributor to its gradual acceptance — five years of real-world data and a head-to-head study demonstrating superior efficacy gave physicians higher confidence in the treatment, he said.
Now J&J’s fastest growing drug, Spravato could become a blockbuster, according to both analysts and the company, with forecasts for $1 billion to $5 billion in peak sales.
Winning expanded indications could help Spravato surpass that threshold. Spravato is currently approved as an adjunctive therapy alongside oral medications in treatment resistant depression and major depressive disorder, and in July, J&J asked the FDA to also greenlight the drug to be prescribed on its own.
“The filing is based on phase 4 data which showed rapid improvement in depressive symptoms at around 24 hours and was sustained through the four weeks endpoint,” Martin said. “If approved, it will be the first monotherapy treatment option available for adults with TRD.”
While J&J currently has a lock on the current market for esketamine, emerging companies are targeting a similar approach but in much earlier stages. Mira Pharmaceuticals, for example, is in preclinical development with a ketamine-based treatment for neuropathic pain and depression and aims to start clinical trials early next year.
For J&J, keeping Spravato’s momentum will be crucial for its plans to become a neuroscience powerhouse.
“Spravato is the foundation for our growing neuroscience portfolio in [major depressive disorder] and a growth driver for J&J,” Martin said.
