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

Abstract

Background: The present study aimed to evaluate the reasons and determinants of BoNT-A discontinuation in patients with stroke, multiple sclerosis, spinal cord injury, and traumatic brain injury. Methods: It is a retrospective study of 56 discontinuer patients treated with botulinum toxin between January 2011 and December 2021. Discontinuation rates and their predictors were estimated using Kaplan–Meier, Log rank test, and Cox’s regression method of analyses.Results: The mean age was 56.54 years, 53.57% were affected by post-stroke spasticity, 17.86% by spinal cord injury, 12.5% and 16.07% by traumatic brain injury and multiple sclerosis, respectively. The median discontinuation time was 5 months. The main reason for discontinuation were logistic problems (37%) and orthopedic surgeries or intrathecal baclofen (27%). Discontinuers were more likely to have severe spasticity (R = 1.785), have no pain (HR = 1.320), no access to rehabilitation services (HR = 1.402), and have cognitive impairment (HR = 1.403). Conclusions: The main reasons for discontinuation are related to logistic issues (due to distance or the absence of an adequate caregiver) and surgical interventions for spasticity, including intrathecal baclofen. It is crucial to identify possible predictors of discontinuation to improve the effectiveness of a multidisciplinary management. The study confirms the crucial role of rehabilitation and caregivers in achieving better long-term outcomes.

Long-Term Spasticity Management in Post-Stroke Patients: Issues and Possible Actions—A Systematic Review with an Italian Expert Opinion

“…In particular, we have included five national guidelines [ 10 , 44 , 45 , 46 , 47 ], two systematic reviews [ 32 , 34 ], a randomized controlled trial [ 43 ], six observational studies [ 22 , 27 , 28 , 35 , 36 , 41 ], three non-systematic reviews [ 33 , 38 , 42 ], a comprehensive overview [ 29 ], consensus report [ 37 ], and three survey-based qualitative studies [ 31 , 39 , 40 ].…”

“…A recent study investigated the reasons for BoNT-A treatment discontinuation in subjects affected by spasticity post-stroke as well as other neurological conditions. Regarding stroke, subjects’ logistics reasons and clinical worsening were the most important causes of discontinuation whereas orthopedic surgeries and intrathecal baclofen therapy were frequently a reason for discontinuation for spinal cord injury and traumatic brain injury [ 35 ].…”

Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis

“…Additionally, we collected only serious adverse events, while a more in-depth investigation could have led to other statistical associations and, possibly, improved persistence [17]. We did not collect reasons for discontinuation, which can include logistics, switches to other spasticity treatments, poor efficacy, and/or tolerability [18]. However, looking at our results, disease worsening in terms of cognitive impairment and DMT failure are most likely responsible for BT discontinuation.…”

Botulinum Neurotoxins: From Toxin to Medicine

“…The authors concluded that it is crucial to identify the possible predictors of discontinuation to improve the efficacy of multidisciplinary management while also confirming the crucial roles of rehabilitation and caregivers in achieving better long-term outcomes [18].…”