Trends in Botulinum Toxin Use among Patients with Multiple Sclerosis: A Population-Based Study

Abstract

There are limited real-world data on the use of botulinum toxin type A (BoNT-A) in patients with multiple sclerosis (MS). Accordingly, this nationwide, population-based, retrospective cohort study aimed to describe BoNT-A treatment trends in patients with MS between 2014 and 2020 in France. This study extracted data from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information, PMSI) covering the entire French population. Among 105,206 patients coded with MS, we identified those who received ≥1 BoNT-A injection, administered within striated muscle for MS-related spasticity and/or within the detrusor smooth muscle for neurogenic detrusor overactivity (NDO). A total of 8427 patients (8.0%) received BoNT-A injections for spasticity, 52.9% of whom received ≥3 BoNT-A injections with 61.9% of the repeated injections administered every 3 to 6 months. A total of 2912 patients (2.8%) received BoNT-A injections for NDO, with a mean of 4.7 injections per patient. Most repeated BoNT-A injections within the detrusor smooth muscle (60.0%) were administered every 5 to 8 months. There were 585 patients (0.6%) who received both BoNT-A injections within striated muscle and the detrusor smooth muscle. Overall, our study highlights a broad range of BoNT-A treatment practices between 2014 and 2020 in patients with MS.

Botulinum Neurotoxins: From Toxin to Medicine

“…This study reinforces the importance of repeated BoNT-A injections to maintain a satisfactory therapeutic outcome against spasticity and neurogenic detrusor overactivity in subjects with multiple sclerosis [7].…”

Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity—A Retrospective Analysis of Practice and Safety

“…This approach offered more robust screening compared to manual methods within our care setting. It is important to note that the coding system, primarily used for medico-economical purposes, may vary among practitioners who may be more or less sensitive to its interest, as already discussed elsewhere [ 9 ]. However, off-label use of BoNT-A may not match with a specific code, and for 38% of our initial cohort, JDLE codes were not used for bladder injections but for other pelvic–perineal sites of injections (urethral sphincter and corpora cavernosa).…”

“…In persons living with spinal cord injuries (SCIs), recent results from the InSCI surveys revealed that more than 75% of respondents reported experiencing spasticity [ 6 ], which was considered troublesome by 48.7% [ 7 ] and associated with poor quality of life in 46% [ 8 ]. In multiple sclerosis (MS), recent findings from the analysis of the French national health data hub, based on ICD-10 codes, revealed that 23.6% of persons suffering from MS were identified as spastic [ 9 ]. Surveys based on symptom questionnaires showed up to 82% of patients reporting spasticity.…”