Long‐term adherence and response to botulinum toxin in different indications

Abstract

ObjectiveThe objective of the study was the analysis of adherence and self‐perceived treatment response to long‐term botulinum neurotoxin type A (BoNT‐A) treatment in different neurological indications.MethodsIn this retrospective, monocentric, observational study, cross‐sectional and longitudinal data of 1351 patients documenting 20705 injection appointments at the BoNT outpatient clinic of Heinrich Heine University Duesseldorf between 1989 and 2014 were retrospectively analyzed. Patients had been treated with BoNT for neurological conditions, including cervical dystonia (CD), blepharospasm (BSP), other dystonia (ODT), hemifacial spasm (HFS), and spasticity (SPAS). The parameters longitudinally analyzed for the entire cohort were therapy duration as well as the mean and cumulative BoNT‐A dose. Cross‐sectionally, for subgroups of at least 721, patients’ global self‐perceived quality of health and life, global self‐perceived reduction of symptoms by BoNT‐A treatment as well as the clinical global impression were evaluated. Furthermore, mouse hemidiaphragm assay antibodies (MHDA‐ABs) were analyzed in a subgroup.ResultsThe mean treatment duration was 4.58 years (95% CI 4.32–4.84), and 678 (50.2%) therapy dropouts of 1351 patients occurred within the first 8 years. Therapy adherence and self‐perceived symptom reduction in long‐term BoNT‐A treatment over the years were significantly longer in BSP, HFS, and CD patients than in ODT and SPAS patients.InterpretationThe treatment indication determines long‐term adherence and self‐perceived symptom reduction in BoNT‐A therapy, which are better in BSP, HFS, and CD patients than in ODT and SPAS patients. MHDA‐ABs had a significant impact on global self‐perceived symptom reduction, but with only a limited degree.

Reasons and Determinants of BoNT-A Treatment Discontinuation in Patients Living with Spasticity: A 10-Year Retrospective Analysis

“…The mean duration of spasticity before the first cycle of injections was 14.52 months (median 5). Our results are in line with a recent study published in 2020, in which adherence to BoNT-A therapy revealed that most treatment dropouts occurred within the first 8 years [ 43 ]. In particular, authors found that long-term therapy adherence was better in blepharospasm, hemifacial spasm, and cervical dystonia patients than in spasticity patients.…”

Significant Long-Lasting Improvement after Switch to Incobotulinum Toxin in Cervical Dystonia Patients with Secondary Treatment Failure

“…During the manufacturing process of the incoBoNT/A preparation (Xeomin ® , Merz Pharmaceuticals ® , Frankfurt, Germany), not only the clostridial complex proteins but also biologically inactive fragments are removed, and the total clostridial protein content of a vial of 100 U Xeomin ® is reduced to 0.44 ng [32], which is much lower than that of the aboor onaBoNT/A preparation [32]. This low protein content of the incoBoNT/A preparation leads to a low antigenicity of incoBoNT/A in comparison to abo-or onaBoNT/A, which was confirmed in an animal experiment [33] and in a recent cross-sectional study in patients who received long-term treatment exclusively with incoBoNT/A without NAB induction [18,34].…”

Real-World Adherence to OnabotulinumtoxinA Treatment for Spasticity: Insights From the ASPIRE Study

“…Previous publications have explored adherence to spasticity treatments. [18][19][20][21][22] However, to the best of our knowledge (see Supplemental Table 7 for search terms), this is one of the first publications to assess real-world adherence to botulinum toxin treatment for spasticity 21,22 and the first to assess adherence to onabotulinumtoxinA specifically across multiple etiologies. Variables associated with adherence and non-adherence to onabotulinumtoxinA treatment in the total and stroke logistic regression models from this analysis of ASPIRE are discussed below.…”

“…21 Lee et al supports this finding, suggesting that "incapability to return to the clinic owning to organizational issues (e.g., transportation, especially for more disabling disorders such as SPAS [spasticity])" may have negatively impacted long-term adherence to botulinum toxin treatment in their study. 22 Alternatively, longer treatment intervals may be consistent with the patient's prescribed treatment regimen.…”

“…Lee et al postulates that older age and disease progression (eg, additional strokes or other comorbidities) could be contributing factors to reduced long-term adherence to botulinum toxin treatment. 22 Patients being treated for thumb-in-palm, which can be a difficult clinical presentation to treat due to inaccessibility of the target muscles (especially if accompanied by clenched fist), was also associated with non-adherence in the stroke model.…”