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Molteni F, Wissel J, Fheodoroff K, Munin MC, Patel AT, Althaus M, Comes G, Dekundy A, Pulte I, Scheschonka A, Vacchelli M, Santamato A. Improvement in Quality-of-Life-Related Outcomes Following Treatment with IncobotulinumtoxinA in Adults with Limb Spasticity: A Pooled Analysis. Toxins (Basel) 2023; 16:19. [PMID: 38251237 PMCID: PMC10821091 DOI: 10.3390/toxins16010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
A strong correlation has been reported between patient-reported quality of life (QoL) and the investigator-rated Disability Assessment Scale (DAS) in patients with spasticity. The current analysis evaluates the effect of incobotulinumtoxinA on QoL-related outcomes (limb position abnormality, as well as dressing- and hygiene-related disability, measured with the DAS) in adults with upper limb spasticity, using pooled data from six studies. Separate analyses for each DAS domain were performed using data from patients with disabilities for that domain (DAS score ≥1). Results showed that a significantly greater proportion of incobotulinumtoxinA-treated compared with placebo-treated patients achieved a ≥1-point reduction from baseline in each of the DAS domains (improvement) 4 weeks after the first injection. The benefits of incobotulinumtoxinA were observed regardless of the baseline severity of DAS impairment and of the time elapsed since stroke. The effects of incobotulinumtoxinA 4 weeks after injection were maintained or enhanced over multiple injection cycles for all three DAS domains, supporting the use of repeated injection cycles to provide sustained QoL benefit. IncobotulinumtoxinA represents an important treatment option to achieve better QoL-related outcomes for patients with upper limb spasticity, irrespective of the duration of their condition.
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Affiliation(s)
- Franco Molteni
- Department of Rehabilitation, Valduce Villa Beretta Hospital, 23845 Costa Masnaga, Italy
| | - Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | | | - Michael C. Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Atul T. Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS 66211, USA
| | - Michael Althaus
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Georg Comes
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Andrzej Dekundy
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Irena Pulte
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Astrid Scheschonka
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Matteo Vacchelli
- Merz Therapeutics GmbH, 60318 Frankfurt am Main, Germany; (M.A.); (G.C.)
| | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
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Jost WH, Kaňovský P, Hast MA, Hanschmann A, Althaus M, Patel AT. Pooled Safety Analysis of IncobotulinumtoxinA in the Treatment of Neurological Disorders in Adults. Toxins (Basel) 2023; 15:353. [PMID: 37368654 DOI: 10.3390/toxins15060353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/27/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The pooled incidences of treatment-emergent adverse events (TEAEs) were examined by indication using the integrated clinical database of Merz-sponsored, placebo-controlled, or repeat-dose studies of incobotulinumtoxinA in adults with cervical dystonia, blepharospasm, limb spasticity, sialorrhea, or essential tremor of the upper limb. Overall incidences of TEAEs, serious TEAEs, TEAEs leading to discontinuation, fatal TEAEs, TEAEs of special interest (TEAESIs; indicating possible toxin spread), and treatment-related (TR) events were determined for incobotulinumtoxinA and placebo after a single injection and for repeated dose cycles of incobotulinumtoxinA. The most frequent events after a single dose of incobotulinumtoxinA are summarized. After a single cycle, incidences of overall TEAEs were similar between incobotulinumtoxinA and the placebo in most indications, although between-indication differences were observed. Few TEAEs led to incobotulinumtoxinA discontinuation; there were no fatal TEAEs with incobotulinumtoxinA. In general, repeated cycles did not increase the incidence of any event. The most frequent TR-TEAEs were indication-dependent, including dysphagia for indications affecting the head or neck. The TR-TEAESIs across all indications were most commonly muscular weakness, dysphagia and dry mouth. Overall, the results of this pooled analysis support and extend the favorable safety and tolerability profile of incobotulinumtoxinA for the treatment of adult neurological disorders established by individual clinical studies.
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Affiliation(s)
| | - Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
| | | | | | | | - Atul T Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS 66211, USA
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Lee J, Chun MH. Safety and Efficacy of HU-014 in the Treatment of Post-Stroke Upper Limb Spasticity: A Phase I Pilot Study. Toxins (Basel) 2022; 14:toxins14110730. [PMID: 36355980 PMCID: PMC9693132 DOI: 10.3390/toxins14110730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 01/26/2023] Open
Abstract
Botulinum toxin type A (BTX-A) is widely used for treating post-stroke upper limb spasticity. We evaluated the safety and efficacy of HU-014 in treating post-stroke upper limb spasticity. Thirteen patients were administered with HU-014. The primary outcome was safety, including adverse events, vital signs, physical examination, laboratory tests, and antibody formation test. The secondary outcomes were changes in the Modified Ashworth Scale (MAS) score for wrist, elbow, and finger flexor; Disability Assessment Scale (DAS); Investigator's Global Assessment (IGA) and Subject's Global Assessment (SGA); Caregiver Burden Scale (CBS); and Columbia Suicide Severity Rating Scale (C-SSRS) at weeks 4, 8, and 12 from baseline. No notable safety-related issues were reported. MAS and DAS scores were significantly decreased from those at baseline at 4, 8, and 12 weeks (p < 0.05). At weeks 4, 8, and 12, the IGA and SGA scores were 5.85 ± 0.55, 5.69 ± 0.48, and 5.62 ± 0.65 and 5.46 ± 1.20, 5.85 ± 0.38, and 5.77 ± 0.73, respectively. CBS scores decreased at all timepoints and those for cutting fingernails significantly decreased at 8 and 12 weeks compared with baseline (p < 0.05). C-SSRS scores showed that suicidal ideation in all patients was "low" at all timepoints. HU-014 is a safe treatment that can improve post-stroke upper limb spasticity.
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Goal-Setting in Multiple Sclerosis-Related Spasticity Treated with Botulinum Toxin: The GASEPTOX Study. Toxins (Basel) 2022; 14:toxins14090582. [PMID: 36136520 PMCID: PMC9504895 DOI: 10.3390/toxins14090582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Spasticity is one of the most disabling symptoms in multiple sclerosis (MS). Botulinum toxin injection (BTI) is a first-line treatment for focal spasticity. There is a lack of evidence of a functional improvement following BTI in MS-related spasticity. To describe goal-setting for BTI in MS, and evaluate the degree of attainment, using goal attainment scaling (GAS) 4-to-6 weeks after injection session, a one-year multi-center retrospective observational study assessing goal-setting and achievement during BTI session in spastic patients with MS was set up. Following the GAS method, patients and their physicians set up to three goals and scored their achievement 4 to 6 weeks thereafter. Commonly used goals from three centers were combined into a standardized list and 125 single BTI sessions were analyzed. The most frequent goals regarded lower limb (LL) impairments (equinovarus foot, toe claw) or locomotion (stability, walking distance, clinging) and accounted for 89.1%, versus 10.9% for upper limb (UL), mostly for mild-to-moderate MS. Overall, goals were frequently achieved (85.77%) mainly when related to gait and mobility rather than hygiene and ease of care. This study gives an overview on the most frequent, relevant, and achievable goals to be set in real-life practice of BTI for spasticity management in MS.
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Pain Reduction in Adults with Limb Spasticity Following Treatment with IncobotulinumtoxinA: A Pooled Analysis. Toxins (Basel) 2021; 13:toxins13120887. [PMID: 34941725 PMCID: PMC8704318 DOI: 10.3390/toxins13120887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Some studies have shown that incobotulinumtoxinA reduces spasticity-associated pain, but further evidence is needed. This exploratory analysis pooled pain-relief data from six Phase 2 or 3 studies of incobotulinumtoxinA (four placebo-controlled studies) for treating upper limb spasticity in adults. Spasticity-associated pain was assessed at baseline and 4 weeks post incobotulinumtoxinA injection using the disability assessment scale (DAS) for pain. Only data for patients with pain at baseline were analysed. Overall, 544 (incobotulinumtoxinA, N = 415; placebo, N = 129) of 937 patients (58.1%) experienced pain at baseline. At Week 4, a significantly greater proportion of incobotulinumtoxinA- (52.1%) than placebo-treated patients (28.7%; Chi-square p < 0.0001) showed a response (≥1-point improvement in DAS pain score). In logistic regression analysis, incobotulinumtoxinA-treated patients were 2.6 times more likely to achieve this endpoint than placebo-treated patients. A significant difference between incobotulinumtoxinA and placebo was observed regardless of baseline pain severity. Additionally, 27.1% of incobotulinumtoxinA- versus 12.4% of placebo-treated patients reported complete pain relief at Week 4 (p = 0.0006). Pain relief increased with multiple injection cycles. To achieve patient-centred care, pain relief may be considered a treatment goal in adults with spasticity-associated pain regardless of pain severity. This study contributes to understanding the benefits of incobotulinumtoxinA in treating limb spasticity-associated pain.
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Andraweera ND, Andraweera PH, Lassi ZS, Kochiyil V. Effectiveness of Botulinum Toxin A Injection in Managing Mobility-Related Outcomes in Adult Patients With Cerebral Palsy: Systematic Review. Am J Phys Med Rehabil 2021; 100:851-857. [PMID: 33252471 DOI: 10.1097/phm.0000000000001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Intramuscular botulinum toxin A (BTX-A) is used in the management of focal spasticity in cerebral palsy (CP). The aim was to conduct a systematic review to assess current literature on the use of BTX-A in the management of mobility-related outcomes among adult persons with spastic CP. METHODS All studies reporting on the use of BTX-A in the management of spastic CP among adult persons were identified by searching the following electronic databases: PubMed, CINAHL, the Cochrane Library, and EMBASE. RESULTS Six studies were included in the review. Most studies were conducted in mixed patient groups comprising patients with movement disorders, traumatic brain injury, CP, and other disorders requiring therapy for spasticity. BTX-A was shown to be effective in improving spasticity-related outcomes among persons with CP, but mixed results were shown for functional outcomes. CONCLUSIONS More studies are required on exclusive CP cohorts using recommended and currently used scales, incorporating quality of life and patient satisfaction scales. Results from long-term follow-up studies will be valuable for better evaluation of the effectiveness of BTX-A in the management of spasticity-related outcomes among adult persons with CP.
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Affiliation(s)
- Nalinda D Andraweera
- From the Department of Rehabilitation Medicine, Modbury Public Hospital, Modbury (NDA, VK); and Adelaide Medical School, The University of Adelaide, Adelaide, Australia (NDA, PHA, ZSL, VK)
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Kaňovský P, Elovic EP, Hanschmann A, Pulte I, Althaus M, Hiersemenzel R, Marciniak C. Duration of Treatment Effect Using IncobotulinumtoxinA for Upper-limb Spasticity: A Post-hoc Analysis. Front Neurol 2021; 11:615706. [PMID: 33551974 PMCID: PMC7862578 DOI: 10.3389/fneur.2020.615706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
The efficacy and safety of incobotulinumtoxinA ≤400 U was demonstrated in subjects with post-stroke upper-limb spasticity in a randomized, double-blind Phase 3 study with an open-label extension (OLEX; EudraCT number 2005-003951-11, NCT00432666). We report a post-hoc analysis of the duration of the treatment effect. Subjects completing the placebo-controlled main period (single injection cycle with 12–20-week observation) entered the OLEX and received a maximum of five further treatments (maximum duration 69 weeks) with incobotulinumtoxinA ≤400 U at flexible intervals with a minimum duration of 12 weeks, based on clinical need. Intervals between two consecutive incobotulinumtoxinA injections, excluding treatment intervals prior to the end-of-study visit, were evaluated. Of 437 incobotulinumtoxinA treatment intervals, 415 received by 136 subjects were included in the post-hoc analysis. More than half (52.3%; 217/415) of all incobotulinumtoxinA reinjections were administered at Week ≥14, 31.1% (129/415) at Week ≥16, 19.0% (79/415) at Week ≥18, and 11.6% (48/415) at Week ≥20. The duration of effect may vary and can exceed 20 weeks or more, which was observed in at least one injection cycle in 29.4% (40/136) subjects over the course of their treatment. Data show that incobotulinumtoxinA retreatment for upper-limb spasticity may not be required at 12-week intervals and provides evidence for flexible treatment intervals beyond this time frame.
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Affiliation(s)
- Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, Olomouc, Czechia
| | - Elie P Elovic
- Moss Rehabilitation, Philadelphia, PA, United States
| | | | - Irena Pulte
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | | | | | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation and the Department of Neurology, Northwestern University Feinberg School of Medicine and Shirley Ryan AbilityLab, Chicago, IL, United States
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Bensmail D, Wissel J, Laffont I, Simon O, Scheschonka A, Flatau-Baqué B, Dressler D, Simpson DM. Efficacy of incobotulinumtoxinA for the treatment of adult lower-limb post-stroke spasticity, including pes equinovarus. Ann Phys Rehabil Med 2020; 64:101376. [PMID: 32294561 DOI: 10.1016/j.rehab.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lower-limb spasticity can impair ambulation and gait, impacting quality of life. OBJECTIVES This ancillary analysis of the TOWER study (NCT01603459) assessed the efficacy of incobotulinumtoxinA for lower-limb post-stroke spasticity including pes equinovarus. METHODS Participants received escalating incobotulinumtoxinA doses (400-800U) across 3 injection cycles. Changes were compared for those treated in the lower limb (with/without upper-limb treatment) or the upper limb only or for participants treated or untreated for pes equinovarus. Outcome measures were those used in the seminal study: resistance to passive movement scale (REPAS), Ashworth Scale (AS), functional ambulation and lower-limb goal attainment. RESULTS Among 132/155 (85%) participants with post-stroke spasticity, in cycles 1, 2 and 3, 99, 119 and 121 participants received lower-limb treatment with mean (SD) total limb incobotulinumtoxinA doses of 189.2 (99.2), 257.1 (115.0) and 321.3 (129.2) U, respectively. Of these, 80, 105 and 107, respectively, were treated for pes equinovarus. The mean (SD) improvement in REPAS lower-limb score was greater with treatment in the lower limb versus the upper limb only: -1.6 (2.1) versus-0.4 (1.4); -1.9 (1.9) versus -0.6 (1.6); -2.2 (2.2) versus -1.0 (0.0) (P=0.0005, P=0.0133 and P=0.3581; analysis of covariance [ANCOVA], between-group differences) in cycles 1, 2 and 3, respectively. For all cycles, the mean improvement in ankle joint AS score from injection to 4 weeks post-treatment was greater for participants treated versus not treated for pes equinovarus, with a significant between-group difference in cycle 1 (P=0.0099; ANCOVA). At the end of cycle 3, 42% of participants walked independently and 63% achieved 2 of 2 lower-limb treatment goals (baseline 23% and 34%, respectively). CONCLUSIONS This study supports the efficacy of incobotulinumtoxinA for treatment of pes equinovarus and other patterns of lower-limb post-stroke spasticity.
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Affiliation(s)
- Djamel Bensmail
- Raymond-Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Boulevard Raymond Poincaré, 92380 Garches, France.
| | - Jörg Wissel
- Department of Neurology, Vivantes Hospital Spandau, Neue Bergstaße, 13585 Berlin, Germany.
| | - Isabelle Laffont
- Lapeyronie University Hospital, Avenue du Doyen Gaston Giraud, 34295 Montpellier, France; Euromov, Montpellier University, IFRH, Avenue du Pic Saint Loup, 34090 Montpellier, France.
| | - Olivier Simon
- Formerly of Merz Pharmaceuticals GmbH, Eckenheimer Landstraße, 60318 Frankfurt am Main, Germany.
| | - Astrid Scheschonka
- Merz Pharmaceuticals GmbH, Eckenheimer Landstraße, 60318 Frankfurt am Main, Germany.
| | - Birgit Flatau-Baqué
- Merz Pharmaceuticals GmbH, Eckenheimer Landstraße, 60318 Frankfurt am Main, Germany.
| | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Street, 30625 Hannover, Germany.
| | - David M Simpson
- Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York 10029, USA.
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León-Valenzuela A, Palacios JS, Del Pino Algarrada R. IncobotulinumtoxinA for the treatment of spasticity in children with cerebral palsy - a retrospective case series focusing on dosing and tolerability. BMC Neurol 2020; 20:126. [PMID: 32268880 PMCID: PMC7140581 DOI: 10.1186/s12883-020-01702-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND IncobotulinumtoxinA (Xeomin®) is a botulinum neurotoxin type A with established efficacy in the treatment of upper-limb spasticity in adults. This retrospective case series in a university hospital setting aimed to elucidate the safety and tolerability of incobotulinumtoxinA for treatment of spasticity in children with cerebral palsy. METHODS Participants received incobotulinumtoxinA injections up to a maximum total dose of 600 U, 24 U/kg body weight. Medical records were reviewed for key demographic information, incobotulinumtoxinA exposure, and adverse effects (AEs). RESULTS Sixty-nine children were included (mean age [SD], 8.3 [3.9] years; 44/69 [63.8%] male). One-hundred-and-ninety-one injections were administered, with mean (SD) of 2.8 (1.5) treatment cycles/participant and dosing interval of 6.0 (1.7) months. The number of muscles injected increased from 2.4 (1.2) at cycle 1 to 4.2 (1.9) at cycle 6. The mean (SD) total incobotulinumtoxinA dose increased from 191.7 (126.2) U, (8.5 [5.4] U/kg body weight) at cycle 1 to 368.0 (170.1) U, (9.9 [5.5] U/kg body weight) at cycle 6. Seventy four adverse effects (37.5% of injections) were reported, the most frequent was injection pain (93.2% of AEs). Only three AEs were considered directly treatment-related by injectors: muscle weakness, generalized weakness, and fever. CONCLUSIONS Our clinical experience indicates that incobotulinumtoxinA is a well-tolerated treatment option for focal spasticity in children with cerebral palsy. TRIAL REGISTRATION As the study was observational and retrospective, no EudraCT registration number was requested. The internal code assigned to the study in the administrative resolution was: 1143-N-15.
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Affiliation(s)
- Angel León-Valenzuela
- Unidad de Gestión Clínica de Rehabilitación, Hospital Puerto Real, Puerto Real, Cádiz, Spain. .,Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, Spain. .,Departamento Materno-Infantil, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.
| | | | - Rogelio Del Pino Algarrada
- Unidad de Gestión Clínica de Rehabilitación, Hospital Puerto Real, Puerto Real, Cádiz, Spain.,Grupo iRehab, Instituto de Investigación e Innovación Biomédica de Cádiz, Cádiz, Spain
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Fheodoroff K, Rekand T, Medeiros L, Koßmehl P, Wissel J, Bensmail D, Scheschonka A, Flatau-Baqué B, Simon O, Dressler D, Simpson DM. Quality of life in subjects with upper- and lower-limb spasticity treated with incobotulinumtoxinA. Health Qual Life Outcomes 2020; 18:51. [PMID: 32131842 PMCID: PMC7055124 DOI: 10.1186/s12955-020-01304-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background We evaluated quality of life among subjects with upper- and lower-limb spasticity who received escalating doses of incobotulinumtoxinA (total body doses up to 800 U) in the prospective, single-arm, dose-titration TOWER study. Methods In this exploratory trial, subjects (N = 155; 18–80 years of age) with upper- and lower-limb spasticity due to cerebral causes who were deemed to require total body doses of up to 800 U incobotulinumtoxinA received three consecutive injection cycles of incobotulinumtoxinA (400, 600, and up to 800 U), each with 12 to 16 weeks’ follow-up. QoL was assessed using the EuroQol 5-dimensions questionnaire, three-level (EQ-5D), before and 4 weeks post-injection in each injection cycle and at the end of injection cycle 3. Results The mean EQ-5D visual analog scale scores of 155 participants continuously improved from study baseline to 4 weeks post-injection in all injection cycles (mean [standard deviation] change 6.7 [14.1], 9.6 [16.3], and 8.6 [17.0] for injection cycles 1, 2, and 3, respectively; p < 0.0001 for all, paired sample t-test). In general, among those with a change in the EQ-5D rating of their condition, the proportion of subjects with ‘improvement’ was greater than that with ‘worsening’ for individual EQ-5D dimensions across all injection cycles. At the end of injection cycle 3, the proportion of subjects rating their condition as ‘normal’ increased from study baseline for all dimensions, and there was a ≥ 46% reduction in the proportion of subjects with a rating of ‘severe impairment’. Conclusion These preliminary results suggest that escalating incobotulinumtoxinA doses up to 800 U are associated with improvement in quality of life ratings in subjects with multifocal upper- and lower-limb spasticity, and form a basis for future comparator studies. Trial registration ClinicalTrials.gov, NCT01603459. Date of registration: May 22, 2012.
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Affiliation(s)
| | | | | | - Peter Koßmehl
- Kliniken Beelitz GmbH, Beelitz-Heilstätten, Beelitz, Germany
| | | | - Djamel Bensmail
- Raymond-Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, Garches, France
| | | | | | - Olivier Simon
- Formerly of Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | | | - David M Simpson
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kurenkov AL, Klochkova OA, Bursagova BI, Karimova HM, Kuzenkova LM, Mamedyarov AM, Namazova-Baranova LS, Agranovich OV, Agranovich AO, Soboleva OA, Khapaeva MM, Batysheva TT, Sarzhina MN. [Efficacy and safety of botulinum toxin type A (IncobotulinumtoxinA) in the treatment of patients with cerebral palsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:37-44. [PMID: 29265085 DOI: 10.17116/jnevro201711711137-44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the safety and clinical and neurophysiological efficacy of xeomin in children with spastic equinus and equinovarus foot deformity in cerebral palsy. MATERIAL AND METHODS Sixty-four patients with spastic forms of cerebral palsy (levels I-IV on the GMFCS) were enrolled into this multi-center open-label comparative randomized trial. The patients were administered xeomin or botox once, each drug being administered to 32 patients. Efficacy was evaluated based on clinical characteristics (the modified Ashworth scale, goniometry) and electromyography data. The subjects were observed for 3 months (90±7 days) after injections. The incidence, severity and intensity of adverse events (AE) was also determined. RESULTS Treatment with xeomin according to the suggested protocol has proven its high clinical efficacy. The efficacy was demonstrated by significant, stable and long-term decrease in the gastrocnemius muscle tone: in the xeomin group, the score on the modified Ashworth scale decreased from 2.6±0.49 points at baseline to 1.8±0.54 points (р<0.000001, paired t-test; р<0.000004, Wilcoxon test). In the botox group, this score decreased from 2.4±0.56 points to 1.6±0.45 points (р<0.000001, paired t-test; р<0.000002, Wilcoxon test). The increased range of ankle joint movements at passive and voluntary feet extension. In the xeomin group, the significant proportion of patients (45.1%) moved to the group of lower spasticity defined as less than two score points on the modified Ashworth scale. The clinical data fully matched the changes in electromyography parameters, which were characterized by the lower amplitude and area of the target muscle (lateral and medial gastrocnemius heads) M-responses. AE developed in three patients (9.4%) administered xeomin and in two patients (6.3%) administered botox. The AE recorded in the study are described in the recommendations on the use of xeomin and botox. In three cases (50.0%), AE intensity was determined as mild, in the remaining three cases (50.0%) as moderate. CONCLUSION The results have shown the safety and efficacy of xeomin in the treatment of gastrocnemius spasticity in pediatric patients with cerebral palsy. These data are confirmed by the lack of significant differences in any clinical or electromyography parameters with the results in the reference group administered botox.
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Affiliation(s)
- A L Kurenkov
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - O A Klochkova
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - B I Bursagova
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - H M Karimova
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - L M Kuzenkova
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - A M Mamedyarov
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - L S Namazova-Baranova
- National medical research center of Children Health, Ministry of Health of Russia, Moscow, Russia
| | - O V Agranovich
- Stavropol State Medical University, Ministry of Healthcare of Russia, Stavropol, Russia
| | - A O Agranovich
- Regional Pediatric Clinic, Stavropol Kray, Stavropol, Russia
| | - O A Soboleva
- Regional Pediatric Clinic, Stavropol Kray, Stavropol, Russia
| | - M M Khapaeva
- Regional Pediatric Clinic, Stavropol Kray, Stavropol, Russia
| | - T T Batysheva
- Research-to-Practice Center of Pediatric Psychiatry and Neurology, Healthcare Department of Moscow City, Moscow, Russia
| | - M N Sarzhina
- Research-to-Practice Center of Pediatric Psychiatry and Neurology, Healthcare Department of Moscow City, Moscow, Russia
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Does botulinum toxin treatment improve upper limb active function? Ann Phys Rehabil Med 2018; 62:234-240. [PMID: 29960017 DOI: 10.1016/j.rehab.2018.05.1320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spasticity following lesions of the central nervous system such as stroke is a major cause of impairment and disability, especially when it affects the upper limb, and can be focally relieved by intramuscular injections of botulinum toxin (BT). Functional improvements of the affected upper limb after a BT focal treatment remain controversial. OBJECTIVE We aimed to assess the functional effects of BT treatment on upper-limb spasticity in the literature, identify flaws and deficiencies in proving these effects and propose leads for future trials. METHODS We searched the MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing the effect of BT injection in upper-limb spasticity. This was a non-systematic narrative review, and the selection of articles was based on the authors' expertise. The review focused on stroke-related spasticity and disability. RESULTS Patients' therapeutic targets involved use of the disability assessment scale (DAS) or goal attainment scale (GAS). Impairments and passive function goals prevailed for active function and participation and were more frequently achieved for the former than the latter. Meta-analyses showed no to mild effect sizes for improvement in upper-limb function but failed to show higher and/or better use of the paretic upper limb in activities of daily living after BT injection. CONCLUSION BT injections for impairment and passive function are related to improved kinematic parameters; however, the relation between relief of spasticity and improved upper-limb activity has not been established. Possible explanations for the lack of functional effect in studies are first, disability is mainly due to muscle weakness rather than spasticity, so patients with the best underlying motricity may benefit the most from BT injections; second, assessment methods may not be adapted to screen eligible patients; third, most studies' endpoints were at 4 to 12 weeks after a single injection, but repeated treatment sessions might be needed to observe functional outcome on the upper limbs; and finally, the association of rehabilitation programs or non-pharmacological treatments may enhance the functional effects of BT injections.
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Synnot A, Chau M, Pitt V, O'Connor D, Gruen RL, Wasiak J, Clavisi O, Pattuwage L, Phillips K. Interventions for managing skeletal muscle spasticity following traumatic brain injury. Cochrane Database Syst Rev 2017; 11:CD008929. [PMID: 29165784 PMCID: PMC6486165 DOI: 10.1002/14651858.cd008929.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Skeletal muscle spasticity is a major physical complication resulting from traumatic brain injury (TBI), which can lead to muscle contracture, joint stiffness, reduced range of movement, broken skin and pain. Treatments for spasticity include a range of pharmacological and non-pharmacological interventions, often used in combination. Management of spasticity following TBI varies from other clinical populations because of the added complexity of behavioural and cognitive issues associated with TBI. OBJECTIVES To assess the effects of interventions for managing skeletal muscle spasticity in people with TBI. SEARCH METHODS In June 2017, we searched key databases including the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid) and others, in addition to clinical trials registries and the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cross-over RCTs evaluating any intervention for the management of spasticity in TBI. Only studies where at least 50% of participants had a TBI (or for whom separate data for participants with TBI were available) were included. The primary outcomes were spasticity and adverse effects. Secondary outcome measures were classified according to the World Health Organization International Classification of Functioning, Disability and Health including body functions (sensory, pain, neuromusculoskeletal and movement-related functions) and activities and participation (general tasks and demands; mobility; self-care; domestic life; major life areas; community, social and civic life). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Data were synthesised narratively; meta-analysis was precluded due to the paucity and heterogeneity of data. MAIN RESULTS We included nine studies in this review which involved 134 participants with TBI. Only five studies reported between-group differences, yielding outcome data for 105 participants with TBI. These five studies assessed the effects of a range of pharmacological (baclofen, botulinum toxin A) and non-pharmacological (casting, physiotherapy, splints, tilt table standing and electrical stimulation) interventions, often in combination. The studies which tested the effect of baclofen and tizanidine did not report their results adequately. Where outcome data were available, spasticity and adverse events were reported, in addition to some secondary outcome measures.Of the five studies with results, three were funded by governments, charities or health services and two were funded by a pharmaceutical or medical technology company. The four studies without useable results were funded by pharmaceutical or medical technology companies.It was difficult to draw conclusions about the effectiveness of these interventions due to poor reporting, small study size and the fact that participants with TBI were usually only a proportion of the overall total. Meta-analysis was not feasible due to the paucity of data and heterogeneity of interventions and comparator groups. Some studies concluded that the intervention they tested had beneficial effects on spasticity, and others found no difference between certain treatments. The most common adverse event was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all outcomes. AUTHORS' CONCLUSIONS The very low quality and limited amount of evidence about the management of spasticity in people with TBI means that we are uncertain about the effectiveness or harms of these interventions. Well-designed and adequately powered studies using functional outcome measures to test the interventions used in clinical practice are needed.
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Affiliation(s)
- Anneliese Synnot
- Monash UniversityCochrane Australia, School of Public Health and Preventive MedicineL4 551 St Kilda RdMelbourneVictoriaAustralia3004
- National Trauma Research Institute, Alfred Hospital, Monash UniversityLevel 4, 89 Commercial RoadMelbourneVictoriaAustralia3004
| | - Marisa Chau
- National Trauma Research Institute, Alfred Hospital, Monash UniversityLevel 4, 89 Commercial RoadMelbourneVictoriaAustralia3004
| | - Veronica Pitt
- Australian & New Zealand Intensive Care Research Centre (ANZIC‐RC), Monash UniversityLevel 6, The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Denise O'Connor
- Monash UniversitySchool of Public Health and Preventive MedicineThe Alfred Centre99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Russell L Gruen
- Nanyang Technological UniversityLee Kong Chian School of Medicine11 Mandalay RoadSingaporeSingapore308232
| | - Jason Wasiak
- University of MelbourneMelbourne School of Health SciencesGrattan Street, ParkvilleMelbourneVictoriaAustralia
| | - Ornella Clavisi
- MOVE muscle, bone & joint health263‐265 Kooyong Rd ElsternwickMelbourneVICAustralia3185
| | - Loyal Pattuwage
- Centre for Evidence and ImplementationEast MelbourneVICAustralia3175
| | - Kate Phillips
- Monash UniversitySchool of Public Health & Preventive MedicineThe Alfred Centre99 Commercial RoadMelbourneVictoriaAustralia3004
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Schrader C, Ebke M, Adib Saberi F, Dressler D. Botulinum toxin therapy in patients with oral anticoagulation: is it safe? J Neural Transm (Vienna) 2017; 125:173-176. [PMID: 29116410 DOI: 10.1007/s00702-017-1809-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
When used therapeutically, botulinum toxin (BT) has to be injected into its target tissues. All manufacturers warn not to do so in patients with oral anticoagulation to avoid haematoma. We wanted to study the haematoma frequency (HF) in patients with anticoagulation receiving BT therapy. 32 patients (16 females, 16 males, age 69.3 ± 10.0 years) with blepharospasm (n = 6), hemifacial spasm (n = 8), post-stroke spasticity (n = 16), and cervical dystonia (n = 2) received BT therapy (needle size 27G, post-injection tissue compression) whilst on anticoagulation (anticoagulation group, AG). 32 patients matched for disease, target muscles, age, and gender received identical BT therapy without anticoagulation (control group, CG). Anticoagulation was performed with phenprocoumon. International normalised ratio (INR) at the time of BT injection was in all patients within the recommended margins of 2.0 and 3.0 (mean 2.6 ± 0.27). Overall HF was 3.0% in AG and 1.8% in CG (not significant). All hematomas occurred in blepharospasm patients (AG 5.2%, CG 2.6%, not significant) and hemifacial spasm patients (AG 3.9%, CG 2.9%, not significant). In cervical dystonia and spasticity there were no haematomas. Throughout an observation period of 4 years, none of the haematomas was surgically relevant. Haematomas are a rare complication of BT therapy, mainly occurring in periocular injections. Anticoagulation only marginally increases HF, provided INR is controlled and appropriate injection techniques are used. Surgically relevant haematomas do not occur. Interruption of oral anticoagulation to perform BT therapy is not justified.
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Affiliation(s)
- Christoph Schrader
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Markus Ebke
- Neurologisches Rehabilitationszentrum, Bad Salzuflen, Germany
| | | | - Dirk Dressler
- Movement Disorders Section, Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke. J Neurol Sci 2017; 378:182-186. [DOI: 10.1016/j.jns.2017.04.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 11/19/2022]
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Abstract
Intramuscular incobotulinumtoxinA (Xeomin(®)) is indicated for the treatment or improvement of adult patients with upper limb spasticity (featured indication), cervical dystonia, blepharospasm and glabellar lines. It is a highly purified formulation of botulinum toxin type A that inhibits acetylcholine signalling at neuromuscular junctions, reducing muscle hypertonia. This narrative review discusses the clinical use of incobotulinumtoxinA in adults with upper limb spasticity and summarizes its pharmacological properties. In single-treatment phase 3 trials, compared with placebo, incobotulinumtoxinA treatment improved muscle tone, global spasticity, functional spasticity-related disability and some aspects of carer burden in adults with upper limb spasticity. These beneficial effects of incobotulinumtoxinA on muscle tone were generally maintained in extension studies, in which up to five additional incobotulinumtoxinA treatments were administered. Functional spasticity-related disability and carer burden were also reduced during longer-term incobotulinumtoxinA treatment. IncobotulinumtoxinA was generally well tolerated in clinical trials, with relatively few patients experiencing treatment-related adverse events, most of which were of mild to moderate intensity. No neutralizing antibodies that would potentially cause secondary nonresponse against incobotulinumtoxinA were detected after single and multiple treatments in these trials or in phase 3 and 4 trials of incobotulinumtoxinA in other indications, which may be an advantage of this purified formulation. Further research would help to more fully determine the impact of neurotoxin purification in terms of reducing the potential risk of immunogenic responses during long-term treatment. Hence, incobotulinumtoxinA is a useful treatment option for upper limb spasticity in adult patients.
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17
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Wissel J, Bensmail D, Ferreira JJ, Molteni F, Satkunam L, Moraleda S, Rekand T, McGuire J, Scheschonka A, Flatau-Baqué B, Simon O, Rochford ETJ, Dressler D, Simpson DM. Safety and efficacy of incobotulinumtoxinA doses up to 800 U in limb spasticity: The TOWER study. Neurology 2017; 88:1321-1328. [PMID: 28283596 PMCID: PMC5379931 DOI: 10.1212/wnl.0000000000003789] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/17/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate safety (primary objective) and efficacy of increasing doses (400 U up to 800 U) of incobotulinumtoxinA (Xeomin, Merz Pharmaceuticals GmbH) for patients with limb spasticity. Methods: In this prospective, single-arm, dose-titration study (NCT01603459), patients (18–80 years) with spasticity due to cerebral causes, who were clinically deemed to require total doses of 800 U incobotulinumtoxinA, received 3 consecutive injection cycles (ICs) with 400 U, 600 U, and 600–800 U incobotulinumtoxinA, respectively, each followed by 12–16 weeks' observation. Outcomes included adverse events (AEs), antibody testing, Resistance to Passive Movement Scale (REPAS; based on the Ashworth Scale), and Goal Attainment Scale. Results: In total, 155 patients were enrolled. IncobotulinumtoxinA dose escalation did not lead to an increased incidence of treatment-related AEs (IC1: 4.5%; IC2: 5.3%; IC3: 2.9%). No treatment-related serious AEs occurred. The most frequent AEs overall were falls (7.7%), nasopharyngitis, arthralgia, and diarrhea (6.5% each). Five patients (3.2%) discontinued due to AEs. No patient developed secondary nonresponse due to neutralizing antibodies. Mean (SD) REPAS score improvements from each injection to 4 weeks postinjection increased throughout the study (IC1: −4.6 [3.9]; IC2: −5.9 [4.2]; IC3: −7.1 [4.8]; p < 0.0001 for all). The proportion of patients achieving ≥3 (of 4) treatment goals also increased (IC1: 25.2%; IC2: 50.7%; IC3: 68.6%). Conclusion: Escalating incobotulinumtoxinA doses (400 U up to 800 U) did not compromise safety or tolerability, enabled treatment in a greater number of muscles/spasticity patterns, and was associated with increased treatment efficacy, improved muscle tone, and goal attainment. ClinicalTrials.gov identifier: NCT01603459. Classification of evidence: This study provides Class IV evidence that, for patients with limb spasticity, escalating incobotulinumtoxinA doses (400 U up to 800 U) increases treatment efficacy without compromising safety or tolerability.
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Affiliation(s)
- Jörg Wissel
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY.
| | - Djamel Bensmail
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Joaquim J Ferreira
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Franco Molteni
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Lalith Satkunam
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Susana Moraleda
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Tiina Rekand
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - John McGuire
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Astrid Scheschonka
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Birgit Flatau-Baqué
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Olivier Simon
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Edward T J Rochford
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - Dirk Dressler
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
| | - David M Simpson
- From Neurorehabilitation (J.W.), Department of Neurology, Vivantes Hospital Spandau, Berlin, Germany; Raymond-Poincaré Hospital (D.B.), AP-HP, University of Versailles Saint Quentin, Garches, France; Instituto de Medicina Molecular (J.J.F.), Faculty of Medicine, University of Lisbon, Portugal; Villa Beretta (F.M.), Rehabilitation Center, Valduce Hospital, Como, Italy; Division of Physical Medicine and Rehabilitation (L.S.), University of Alberta, Edmonton, Canada; Department of Physical Medicine and Rehabilitation (S.M.), University Hospital La Paz, Madrid, Spain; Department of Neurology (T.R.), Haukeland University Hospital, Bergen, Norway; Medical College of Wisconsin (J.M.), Milwaukee; Merz Pharmaceuticals GmbH (A.S., B.F.-B., O.S.), Frankfurt am Main, Germany; Complete Medical Communications (E.T.J.R.), Macclesfield, UK; Movement Disorders Section (D.D.), Department of Neurology, Hannover Medical School, Hannover, Germany; and Icahn School of Medicine at Mount Sinai (D.M.S.), New York, NY
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Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force. J Neurol 2016; 264:112-120. [PMID: 27787630 DOI: 10.1007/s00415-016-8304-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.
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Carraro E, Trevisi E, Martinuzzi A. Safety profile of incobotulinum toxin A [Xeomin(®)] in gastrocnemious muscles injections in children with cerebral palsy: Randomized double-blind clinical trial. Eur J Paediatr Neurol 2016; 20:532-7. [PMID: 27177451 DOI: 10.1016/j.ejpn.2016.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/25/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The only two preparations of botulinum toxin A for which there are published evidences of efficacy in children with cerebral palsy are onabotulinum toxin A (Botox(®)) and abobotulinum toxin A (Dyport(®)); these toxins should be considered generally safe and appropriate in the treatment for localized upper and lower limb spasticity. AIMS To establish the safety profile of incobotulinum toxin A (Xeomin(®)) in children with cerebral palsy and muscle spasticity. METHODS Randomized double-blind controlled trial that involved the recruitment of children of both sexes with spastic hemiplegia or diplegia in cerebral palsy, aged between 3 and 18 years. Children were randomized to either the study group (SG, incobotulinum toxin A) or the control group (CG, onabotulinum toxin A) both to be injected with 5units/kg on gastrocnemius (medialis and lateralis) muscles. The occurrence of adverse events at baseline, after 48 h, 10 days and 3 months was recorded by the caregivers in a checklist that listed both common and uncommon side effects. RESULTS 35 patients were treated (CG = 18; SG = 17); the 2 groups were well balanced regarding demographics and anthropometry characteristics. At least 1 adverse event occurred in 49% of patients within first 2 days, 46% between 2 and 10 days, and 12% between 10 and 90 days. All the reported events were minor; no serious adverse event was recorded. Fatigue was the most frequent complaint. There was no significant difference in frequency and type of events between the 2 groups. CONCLUSION Incobotulinum toxin A and onabotulinum toxin A share similar profile of safety in the treatment of lower limb spasticity in CP children.
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Affiliation(s)
- Elena Carraro
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
| | - Enrico Trevisi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Andrea Martinuzzi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
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Santamato A, Ranieri M, Solfrizzi V, Lozupone M, Vecchio M, Daniele A, Greco A, Seripa D, Logroscino G, Panza F. High doses of incobotulinumtoxinA for the treatment of post-stroke spasticity: are they safe and effective? Expert Opin Drug Metab Toxicol 2016; 12:843-6. [DOI: 10.1080/17425255.2016.1198318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section-‘OORR Hospital’, University of Foggia, Foggia, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section-‘OORR Hospital’, University of Foggia, Foggia, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro, Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Michele Vecchio
- Department of Medical Sciences, UOC Physical Medicine and Rehabilitation, AOU ‘O.V.E-Policlinico’, Catania, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Greco
- Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Davide Seripa
- Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, ‘Pia Fondazione Cardinale G. Panico’, Lecce, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
- Department of Clinical Research in Neurology, University of Bari Aldo Moro, ‘Pia Fondazione Cardinale G. Panico’, Lecce, Italy
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Zeuner KE, Deuschl G. Pharmacokinetics and pharmacodynamics of incobotulinumtoxinA influencing the clinical efficacy in post-stroke spasticity. Expert Opin Drug Metab Toxicol 2016; 12:457-66. [DOI: 10.1517/17425255.2016.1152262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Santamato A. Safety and efficacy of incobotulinumtoxinA as a potential treatment for poststroke spasticity. Neuropsychiatr Dis Treat 2016; 12:251-63. [PMID: 26869793 PMCID: PMC4737345 DOI: 10.2147/ndt.s86978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity after stroke showing efficacy, reversibility, and low prevalence of complications. In recent years, incobotulinumtoxinA, a new Botulinum toxin type A free of complexing proteins, has been used for treating several movement disorders with safety and efficacy. IncobotulinumtoxinA is currently approved for treating spasticity of the upper limb in stroke survivors, even if several studies described the use also in lower limb muscles. In the present review article, we examine the safety and effectiveness of incobotulinumtoxinA for the treatment of spasticity after stroke.
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Affiliation(s)
- Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital," University of Foggia, Foggia, Italy
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23
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Elovic EP, Munin MC, Kaňovský P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxina for upper-limb post-stroke spasticity. Muscle Nerve 2015. [PMID: 26201835 PMCID: PMC5064747 DOI: 10.1002/mus.24776] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Efficacy and safety of incobotulinumtoxinA in post-stroke upper-limb spasticity were studied. METHODS Subjects randomized 2:1 to incobotulinumtoxinA (fixed dose 400 U) or placebo, with fixed doses for the primary target clinical pattern (PTCP; flexed elbow, 200 U; flexed wrist, 150 U; clenched fist, 100 U). Doses for non-primary patterns were flexible within predefined ranges. RESULTS At week 4, incobotulinumtoxinA led to larger improvements in PTCP Ashworth scale (AS) scores than placebo [least-squares mean change ± standard error: -0.9 ± 0.06 (n = 171) vs. -0.5 ± 0.08 (n = 88); P < 0.001], and more subjects were PTCP AS responders (≥1-point improvement) with incobotulinumtoxinA (69.6%) than with placebo (37.5%; P < 0.001). Investigator's Global Impression of Change confirmed superiority of incobotulinumtoxinA vs. placebo (P = 0.003). IncobotulinumtoxinA was associated with functional improvements, as demonstrated in responder rates for Disability Assessment Scale principal target at week 4 (P = 0.007). Adverse events were mainly mild/moderate, and were reported by 22.4% (incobotulinumtoxinA) and 16.8% (placebo) of subjects. CONCLUSIONS IncobotulinumtoxinA significantly improved upper-limb spasticity and associated disability, and was well-tolerated.
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Affiliation(s)
- Elie Paul Elovic
- HealthSouth Rehabilitation Hospital of Utah, 8074 South 1300 East, Sandy, Utah, 84094, USA
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacky University Olomouc, Olomouc, Czech Republic
| | | | | | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Rehabilitation Institute of Chicago, Chicago, Illinois, USA
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Adverse Clinical Effects of Botulinum Toxin Intramuscular Injections for Spasticity. Can J Neurol Sci 2015; 43:298-310. [PMID: 26597813 DOI: 10.1017/cjn.2015.314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The adverse events (AEs) with botulinum toxin type-A (BoNTA), used for indications other than spasticity, are widely reported in the literature. However, the site, dose, and frequency of injections are different for spasticity when compared to the treatment for other conditions and hence the AEs may be different as well. The objective of this study was to summarize the AEs reported in Canada and systematically review the AEs with intramuscular botulinum toxin injections to treat focal spasticity. METHODS Data were gathered from Health Canada (2009-2013) and major electronic databases. RESULTS In a 4 year period, 285 AEs were reported. OnabotulinumtoxinA (n=272 events): 68% females, 53% serious, 18% hospitalization, and 8% fatalities. The type of AEs reported were - muscle weakness (19%), oropharyngeal (14%), respiratory (14%), eye related (8%), bowel/bladder related (8%), and infection (5%). IncobotulinumtoxinA (n=13): 38% females, 62% serious, and 54% hospitalization. The type of AEs reported were - muscle weakness (15%), oropharyngeal (15%), respiratory (38%), eye related (23%), bowel/bladder related (15%), and infection (15%). Commonly reported AEs in the literature were muscle weakness, pain, oropharyngeal, bowel/bladder, blood circulation, neurological, gait, and respiratory problems. CONCLUSION While BoNTA is useful in managing spasticity, future studies need to investigate the factors that can minimize AEs. A better understanding of the underlying mechanisms of the AEs can also improve guidelines for BoNTA administration and enhance outcomes.
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Jost WH, Benecke R, Hauschke D, Jankovic J, Kaňovský P, Roggenkämper P, Simpson DM, Comella CL. Clinical and pharmacological properties of incobotulinumtoxinA and its use in neurological disorders. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:1913-26. [PMID: 25897202 PMCID: PMC4389813 DOI: 10.2147/dddt.s79193] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background IncobotulinumtoxinA (Xeomin®) is a purified botulinum neurotoxin type A formulation, free from complexing proteins, with proven efficacy and good tolerability for the treatment of neurological conditions such as blepharospasm, cervical dystonia (CD), and post-stroke spasticity of the upper limb. This article provides a comprehensive overview of incobotulinumtoxinA based on randomized controlled trials and prospective clinical studies. Summary IncobotulinumtoxinA provides clinical efficacy in treating blepharospasm, CD, and upper-limb post-stroke spasticity based on randomized, double-blind, placebo-controlled trials with open-label extension periods (total study duration up to 89 weeks). Adverse events were generally mild or moderate. The most frequent adverse events, probably related to the injections, included eyelid ptosis and dry eye in the treatment of blepharospasm, dysphagia, neck pain, and muscular weakness in patients with CD, and injection site pain and muscular weakness when used for treating spasticity. In blepharospasm and CD, incobotulinumtoxinA was investigated in clinical trials permitting flexible intertreatment intervals based on the individual patient’s clinical need; the safety profile of intervals shorter than 12 weeks was comparable to intervals of 12 weeks and longer. There were no cases of newly formed neutralizing antibodies during the Phase III and IV incobotulinumtoxinA trials. Phase III head-to-head trials of incobotulinumtoxinA versus onabotulinumtoxinA for the treatment of blepharospasm and CD have demonstrated therapeutic equivalence of both formulations. Additional Phase III trials of incobotulinumtoxinA in conditions such as lower-limb spasticity, spasticity in children with cerebral palsy, and sialorrhea in various neurological disorders are ongoing. Conclusion IncobotulinumtoxinA is an effective, well-tolerated botulinum neurotoxin type A formulation. Data from randomized clinical trials and further observational studies are expected to help physicians to optimize treatment by tailoring the choice of formulation, dose, and treatment intervals to the patient’s clinical needs.
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Affiliation(s)
- Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg, Germany
| | - Reiner Benecke
- Clinic and Policlinic for Neurology, University of Rostock, Rostock, Germany
| | - Dieter Hauschke
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Petr Kaňovský
- Department of Neurology, Palacky University Olomouc, Faculty of Medicine and Dentistry and University Hospital, Olomouc, Czech Republic
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Phadke CP, Davidson C, Ismail F, Boulias C. The Effect of Neural Lesion Type on Botulinum Toxin Dosage: A Retrospective Chart Review. PM R 2013; 6:406-11. [DOI: 10.1016/j.pmrj.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 10/17/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022]
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Ashford S, Turner-Stokes L. Systematic review of upper-limb function measurement methods in botulinum toxin intervention for focal spasticity. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2013; 18:178-89. [PMID: 23630050 DOI: 10.1002/pri.1554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/22/2013] [Accepted: 03/27/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE This paper aimed to select studies evaluating botulinum toxin (BoNT) intervention applied for upper-limb spasticity and from these identify outcome measures that are a) applicable in the hemiparetic upper limb and b) include evaluation of functional outcome in the context of everyday real-life activities. METHODS A systematic search was used to identify peer-reviewed papers evaluating BoNT intervention for focal spasticity management in the upper limb. From these papers, outcome evaluation methods were identified, which attempted to capture 'active function' improvement (functional use of the hand and/or arm) or passive function improvement (care for the affected limb, for example to maintain hygiene and dress or support the arm). RESULTS The search yielded 411 studies. Seventy papers were identified following a final review of the abstracts as potentially including evaluation of functional outcome (active and/or passive function). Following the review of the papers, a total of 22 studies contained specific methods for evaluating functional outcome in the upper limb. DISCUSSION Three different patient-focused methods to evaluate functional outcome following focal spasticity intervention using BoNT have been identified: 1) use of patient report of upper-limb items (including the Leeds Adult Spasticity Impact Scale and the Disability Assessment Scale), 2) use of a composite measure of function incorporating functional items and 3) Goal Attainment Scaling. None of these methods fully address evaluation of functional outcome in this context but may go some way to recording these improvements. An alternative or complementary measure, recently published, is the Arm Activity Measure for evaluation of active and passive function in this context. The Arm Activity Measure addresses active and passive function changes from the perspective of patients and carers and has been developed for application in this context.
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Affiliation(s)
- Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK.
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Esquenazi A, Albanese A, Chancellor MB, Elovic E, Segal KR, Simpson DM, Smith CP, Ward AB. Evidence-based review and assessment of botulinum neurotoxin for the treatment of adult spasticity in the upper motor neuron syndrome. Toxicon 2012; 67:115-28. [PMID: 23220492 DOI: 10.1016/j.toxicon.2012.11.025] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/27/2012] [Accepted: 11/29/2012] [Indexed: 11/24/2022]
Abstract
Botulinum neurotoxin (BoNT) can be injected to achieve therapeutic benefit across a large range of clinical conditions. To assess the efficacy and safety of BoNT injections for the treatment of spasticity associated with the upper motor neuron syndrome (UMNS), an expert panel reviewed evidence from the published literature. Data sources included English-language studies identified via MEDLINE, EMBASE, CINAHL, Current Contents, and the Cochrane Central Register of Controlled Trials. Evidence tables generated in the 2008 Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (AAN) review of the use of BoNT for autonomic disorders were also reviewed and updated. The panel evaluated evidence at several levels, supporting BoNT as a class, the serotypes BoNT-A and BoNT-B, as well as the four individual commercially available formulations: abobotulinumtoxinA (A/Abo), onabotulinumtoxinA (A/Ona), incobotulinumtoxinA (A/Inco), and rimabotulinumtoxinB (B/Rima). The panel ultimately made recommendations on the effectiveness of BoNT for the management of spasticity, based upon the strength of clinical evidence and following the AAN classification scale. While the prior report by the AAN provided recommendations for the use of BoNT as a class of drug, this report provides more detail and includes recommendations for the individual formulations. For the treatment of upper limb spasticity, the evidence supported a Level A recommendation for BoNT-A, A/Abo, and A/Ona, with a Level B recommendation for A/Inco; there was insufficient evidence to support a recommendation for B/Rima. For lower limb spasticity, there was sufficient clinical evidence to support a Level A recommendation for A/Ona individually and BoNT-A in aggregate; the clinical evidence for A/Abo supported a Level C recommendation; and there was insufficient information to recommend A/Inco and B/Rima (Level U). There is a need for further comparative effectiveness studies of the available BoNT formulations for the management of spasticity.
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Affiliation(s)
- Alberto Esquenazi
- MossRehab & Albert Einstein Medical Center, 60 Township Line Rd., Elkins Park, PA 19027, USA.
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Efficacy and safety of higher doses of botulinum toxin type A NT 201 free from complexing proteins in the upper and lower limb spasticity after stroke. J Neural Transm (Vienna) 2012; 120:469-76. [DOI: 10.1007/s00702-012-0892-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 08/20/2012] [Indexed: 11/27/2022]
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