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Comella CL, Jankovic J, Hauser RA, Patel AT, Banach MD, Ehler E, Vitarella D, Rubio RG, Gross TM. Efficacy and Safety of DaxibotulinumtoxinA for Injection in Cervical Dystonia: ASPEN-1 Phase 3 Randomized Controlled Trial. Neurology 2024; 102:e208091. [PMID: 38295339 PMCID: PMC10962918 DOI: 10.1212/wnl.0000000000208091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES ASPEN-1 was a phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy, duration of response, and safety of 2 doses of DaxibotulinumtoxinA for Injection (DAXI), a novel botulinum toxin type A formulation in participants with cervical dystonia (CD). METHODS Adults (aged 18-80 years) with moderate-to-severe CD (Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] total score ≥20) were enrolled at 60 sites across 9 countries in Europe and North America. Participants were randomized (3:3:1) to single-dose intramuscular DAXI 125U, 250U, or placebo and followed for up to 36 weeks after injection. The primary end point was change from baseline in TWSTRS total score averaged across weeks 4 and 6. Key secondary end points included duration of effect, Clinical and Patient Global Impression of Change (CGIC, PGIC), TWSTRS subscale scores, and safety. Multiplicity-adjusted intent-to-treat hypothesis tests with multiple imputation were performed using ANCOVA and Cochran-Mantel-Haenszel analyses. RESULTS Of 444 individuals screened, 301 were randomized to DAXI 125U (n = 125) or 250U (n = 130) or placebo (n = 46). DAXI 125U and 250U significantly improved the mean TWSTRS total score vs placebo (least squares mean [standard error] difference vs placebo: DAXI 125U, -8.5 [1.93], p < 0.0001; DAXI 250U, -6.6 [1.92], p = 0.0006). The median duration of effect (time from treatment until loss of ≥80% of the peak improvement in average TWSTRS total score achieved at weeks 4 and 6) was 24.0 (95% confidence interval 20.3-29.1) weeks with DAXI 125U and 20.3 (16.7-24.0) weeks with DAXI 250U. Significant improvements were also observed with DAXI in CGIC and PGIC responder rates and TWSTRS subscales. Treatment-related treatment-emergent adverse events (TEAEs) were reported by 29.6% of participants with DAXI 125U, 23.8% with DAXI 250U, and 17.4% with placebo, with injection site pain being the most common overall. The most frequently reported treatment-related TEAEs of interest in DAXI 125U, DAXI 250U, and placebo, respectively, were muscular weakness (4.8%, 2.3%, 0%), musculoskeletal pain (2.4%, 3.1%, 0%), and dysphagia (1.6%, 3.8%, 0%). DISCUSSION This study demonstrated that DAXI, at doses of 125U and 250U, is an effective, safe, long-acting, and well-tolerated treatment for CD. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier (NCT03608397, submitted July 11, 2018) and EU Clinical Trials Register (ClinicalTrialsRegister.eu EudraCT identifier 2018-000446-19, submitted September 13, 2018). First participant enrolled on June 11, 2018. Trial registration was performed in accordance with the Food and Drug Administration Amendments Act (FDAAA 801), which stipulates that the responsible party register an applicable clinical trial not later than 21 calendar days after enrolling the first human participant (42 CFR 11.24). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in adults with moderate-to-severe idiopathic cervical dystonia, DAXI reduces dystonia more effectively than placebo.
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Affiliation(s)
- Cynthia L Comella
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Joseph Jankovic
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Robert A Hauser
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Atul T Patel
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Marta D Banach
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Edvard Ehler
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Domenico Vitarella
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Roman G Rubio
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Todd M Gross
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
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Bensmail D, Karam P, Forestier A, Loze JY, Lévy J. Trends in Botulinum Toxin Use among Patients with Multiple Sclerosis: A Population-Based Study. Toxins (Basel) 2023; 15:toxins15040280. [PMID: 37104218 PMCID: PMC10142089 DOI: 10.3390/toxins15040280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
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.
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Affiliation(s)
- Djamel Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
| | | | | | | | - Jonathan Lévy
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
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Stephen CD, Dy-Hollins M, Gusmao CMD, Qahtani XA, Sharma N. Dystonias: Clinical Recognition and the Role of Additional Diagnostic Testing. Semin Neurol 2023; 43:17-34. [PMID: 36972613 DOI: 10.1055/s-0043-1764292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Dystonia is the third most common movement disorder, characterized by abnormal, frequently twisting postures related to co-contraction of agonist and antagonist muscles. Diagnosis is challenging. We provide a comprehensive appraisal of the epidemiology and an approach to the phenomenology and classification of dystonia, based on the clinical characteristics and underlying etiology of dystonia syndromes. We discuss the features of common idiopathic and genetic forms of dystonia, diagnostic challenges, and dystonia mimics. Appropriate workup is based on the age of symptom onset, rate of progression, whether dystonia is isolated or combined with another movement disorder or complex neurological and other organ system eatures. Based on these features, we discuss when imaging and genetic should be considered. We discuss the multidisciplinary treatment of dystonia, including rehabilitation and treatment principles according to the etiology, including when pathogenesis-direct treatment is available, oral pharmacological therapy, chemodenervation with botulinum toxin injections, deep brain stimulation and other surgical therapies, and future directions.
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Affiliation(s)
| | - Marisela Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Xena Al Qahtani
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Boyce MJ, McCambridge AB, Bradnam LV, Canning CG, Verhagen AP. The barriers and facilitators to satisfaction with botulinum neurotoxin treatment in people with cervical dystonia: a systematic review. Neurol Sci 2022; 43:4663-4670. [PMID: 35593979 PMCID: PMC9349125 DOI: 10.1007/s10072-022-06114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
Background Cervical dystonia (CD) is an isolated, focal, idiopathic dystonia affecting the neck and upper back. CD is usually treated by botulinum neurotoxin (BoNT) injections into the dystonic muscles; however, about 20% of people will discontinue BoNT therapy. This systematic review aimed to determine the barriers to satisfaction and facilitators that could improve satisfaction with BoNT therapy for people with CD. Methods A database search for journal articles investigating satisfaction with BoNT treatment in CD identified seven qualitative studies and one randomised controlled trial. Results were grouped into “direct” and “indirect” barriers and facilitators. Results The most reported direct barrier to satisfaction with BoNT was treatment non-response, reported by up to 66% of participants. Other direct barriers included negative side effects, early wearing-off of treatment effect and inexperience of the treating physician. Indirect barriers included limited accessibility to treatment (including cost) and personal choice. Direct facilitators of satisfaction with BoNT included relief of symptoms and flexible re-treatment intervals. Indirect facilitators included easy accessibility to treatment. Conclusions Despite BoNT having a discontinuation rate of only 20%, it appears a much greater proportion of people with CD are dissatisfied with this treatment. As BoNT is currently the main treatment offered to people with CD, efforts to improve treatment response rates, reduce side effects and make treatment more flexible and readily available should be adopted to improve the quality of life for people with CD. Supplementary information The online version contains supplementary material available at 10.1007/s10072-022-06114-8.
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Impairment of sleep homeostasis in cervical dystonia patients. Sci Rep 2022; 12:6866. [PMID: 35477733 PMCID: PMC9046419 DOI: 10.1038/s41598-022-10802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Alterations in brain plasticity seem to play a role in the pathophysiology of cervical dystonia (CD). Since evidences indicate that sleep regulates brain plasticity, we hypothesized that an alteration in sleep homeostatic mechanisms may be involved in the pathogenesis of CD. We explored sleep in control subjects (CTL) and CD patients before (Tpre-BoNT) and after (Tpost-BoNT) botulinum toxin (BoNT) treatment. A physiological slow wave activity (SWA) power decrease throughout the night was observed in CTL but not in CD at Tpre-BoNT. BoNT restored the physiological SWA decrease in CD at Tpost-BoNT. Furthermore, in the first part of the night, CD at Tpost-BNT showed a frontal increase and parietal decrease in SWA power compared to CD at Tpre-BoNT, with a SWA distribution comparable to that observed in CTL. Our data highlighted a pathophysiological relationship between SWA during sleep and CD and provided novel insight into the transient central plastic effect of BoNT.
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Solish N, Carruthers J, Kaufman J, Rubio RG, Gross TM, Gallagher CJ. Overview of DaxibotulinumtoxinA for Injection: A Novel Formulation of Botulinum Toxin Type A. Drugs 2021; 81:2091-2101. [PMID: 34787840 PMCID: PMC8648634 DOI: 10.1007/s40265-021-01631-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
Botulinum toxin type A (BoNTA) products are widely used for therapeutic and aesthetic indications, but there is a need for longer-lasting treatments that maintain symptom relief between injections and reduce the frequency of re-treatment. DaxibotulinumtoxinA for Injection (DAXI) is a novel BoNTA product containing highly purified 150-kDa core neurotoxin and is the first to be formulated with a proprietary stabilizing excipient peptide (RTP004) instead of human serum albumin. The positively charged RTP004 has been shown to enhance binding of the neurotoxin to neuronal surfaces, which may enhance the likelihood of neurotoxin internalization. DAXI produces robust, extended efficacy across both aesthetic and therapeutic indications. In an extensive glabellar lines clinical program, DAXI showed a high degree of efficacy, a consistent median time to loss of none or mild glabellar line severity of 24 weeks, and median time until return to baseline of up to 28 weeks. In adults with cervical dystonia, DAXI at 125 U and 250 U significantly improved Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores, with a median duration of efficacy of 24 and 20 weeks, respectively, which compares favorably with the 12–14 weeks’ duration reported for approved BoNTA products. Overall, DAXI was well tolerated, and the consistent extended duration of effect suggests that DAXI has the potential to improve the management of both aesthetic and therapeutic conditions. Botulinum toxin is used to block the nerve signals that cause muscles to contract. Products containing botulinum toxin are commonly given by injection to treat muscle spasms (such as cervical dystonia, a painful condition where the neck muscles contract involuntarily) and for cosmetic treatment of frown lines. However, the effects of the currently approved botulinum toxin products typically wear off about 3–4 months after injection and so the injections must be repeated regularly. A new product called DAXI (DaxibotulinumtoxinA for Injection) has been developed. In this product, the botulinum toxin is formulated with a unique protein (called RTP004) that has been designed to help deliver the botulinum toxin to the nerve cells. Research suggests that the RTP004 protein in DAXI adheres the botulinum toxin to the nerves close to the injection site, potentially making its effect last longer. To date, DAXI has been studied in over 3800 patients. The studies have shown that DAXI is effective for treating neck spasms (cervical dystonia) and for reducing the appearance of frown lines. Importantly, the effects of DAXI lasted up to 6 months, which is longer than seen with other botulinum toxin products. The side effects seen with DAXI are consistent in nature and frequency with those seen with other botulinum toxin products. These findings suggest that DAXI can improve both medical and cosmetic treatments due to its longer-lasting effect.
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Affiliation(s)
| | - Jean Carruthers
- University of British Columbia and Jean Carruthers Cosmetic, Vancouver, BC, Canada
| | - Joely Kaufman
- Skin Associates of South Florida, Coral Gables, FL, USA
| | - Roman G Rubio
- Revance Therapeutics, Inc., 7555 Gateway Boulevard, Newark, CA, 94560, USA
| | - Todd M Gross
- Revance Therapeutics, Inc., 7555 Gateway Boulevard, Newark, CA, 94560, USA
| | - Conor J Gallagher
- Revance Therapeutics, Inc., 7555 Gateway Boulevard, Newark, CA, 94560, USA.
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[Treatment satisfaction in patients with cervical dystonia : Subgroup analysis of INTEREST-IN-CD-2]. DER NERVENARZT 2021; 92:1268-1275. [PMID: 33942135 PMCID: PMC8648643 DOI: 10.1007/s00115-021-01120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/03/2022]
Abstract
Hintergrund Obwohl Botulinumtoxin‑A (BoNT-A) von Leitlinien als First-line-Therapie der fokalen zervikalen Dystonie (ZD) empfohlen wird, existieren kaum Langzeitdaten zu den Behandlungsmodalitäten in der klinischen Routine. Fragestellung Die vorliegende Subgruppenanalyse untersuchte Patientenzufriedenheit und Symptomkontrolle unter Berücksichtigung von Behandlungsmodalitäten der BoNT-A-Therapie zwischen ZD-Patienten in Deutschland und Österreich (DE/AT, n = 79) und der internationalen Gesamtkohorte (n = 995). Material und Methoden INTEREST-IN-CD2 war eine prospektive, multizentrische, longitudinale Beobachtungsstudie, die über 3 Jahre der Therapie erwachsener Patienten mit idiopathischer ZD unter BoNT-A-Behandlung folgte. Primärer Endpunkt war die Patientenzufriedenheit mit der Therapie gemessen an der maximalen Zufriedenheit zwischen 2 Injektionen und der Zufriedenheit zum Zeitpunkt der Reinjektion. Ergebnisse Die Therapiezufriedenheit im Wirkmaximum war in beiden Populationen im Studienverlauf stabil und vergleichbar gut (82,3–92,7 % bzw. 85,0–89,9 %). Mit nachlassender BoNT-A-Wirkung zum Ende des Behandlungsintervalls sank die Zufriedenheit ab: Zu Studienbeginn in beiden Gruppen ähnlich (54,2 % vs. 51,4 %), fiel sie numerisch in der der DE/AT-Gruppe bis auf 32,7 % ab, blieb dagegen in der Gesamtpopulation stabil. Die Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)- und Tsui-Scores zeigten keine wesentlichen Unterschiede zwischen der DE/AT-Gruppe und der Gesamtpopulation. Schlussfolgerungen Die Studie bestätigt insgesamt eine gute klinische Symptomkontrolle durch BoNT‑A. Die im Vergleich von DE/AT zur internationalen Gesamtkohorte gesehenen numerischen Unterschiede in der aktuellen Zufriedenheit sind möglicherweise bedingt durch abweichende Anteile BoNT-A-naiver Patienten beider Gruppen, da diese unterschiedliche Zufriedenheit als vorbehandelte Patienten äußerten. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00115-021-01120-1) enthält weitere Infomaterialien. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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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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Salvador PTCDO, Alves KYA, Rodrigues CCFM, Oliveira LVE. Online data collection strategies used in qualitative research of the health field: a scoping review. Rev Gaucha Enferm 2020; 41:e20190297. [DOI: 10.1590/1983-1447.2020.20190297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023] Open
Abstract
ABSTRACT Objective: To identify and map the online data collection strategies used in qualitative researches in the health field. Methods: This is a scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from the Joanna Briggs Institute. We analyzed scientific articles, theses and dissertations from 12 databases. The analysis was made by descriptive statistics. Results: The final sample consisted of 121 researches. It was found that the number of publications increased sharply in the last five years, with predominance of studies from the United Kingdom. The highlight fields were psychology (28.1%), medicine (25.6%) and nursing (12.4%). The publications used 10 online data collection strategies: Online questionnaires, online forums, Facebook, websites, blogs, e-mail, online focus group, Twitter, chats, and YouTube. Conclusions: Online data collection strategies are constantly expanding and increasingly used in the health area.
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Castagna A, Caronni A, Crippa A, Sciumè L, Giacobbi G, Corrini C, Montesano A, Ramella M. Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia-an observational study. Neurol Sci 2019; 41:131-138. [PMID: 31478151 DOI: 10.1007/s10072-019-04061-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Idiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD. METHODS Fifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection. RESULTS Six weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT. CONCLUSIONS SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients' difficulties in the activities of daily living. TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).
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Affiliation(s)
- Anna Castagna
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Antonio Caronni
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy.
| | - Alessandro Crippa
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Luciana Sciumè
- U. O. di Medicina riabilitativa e neuroriabilitazione, Ospedale Niguarda, Milan, Italy
| | - Giulia Giacobbi
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Chiara Corrini
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Angelo Montesano
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Marina Ramella
- U. O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, via Alfonso Capecelatro 66, 20148, Milan, Italy
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Abstract
PURPOSE Dystonia is a chronic and incurable movement disorder. This qualitative study aimed to enhance understanding of the condition by exploring the experience of living with dystonia. METHOD Interpretative phenomenological analysis was used to analyse data gathered through semi-structured interviews. Eight participants were recruited via a UK-based dystonia charity. RESULTS Three superordinate themes emerged from the data: (1) dealing with ignorance and uncertainty: navigating health services with a rare, poorly understood condition; (2) the challenge of social isolation: overcoming barriers to positive social identity; and (3) fear of psychological explanations: the impact of stigmatised attitudes towards psychological explanations for dystonia symptoms. CONCLUSION Coping with a rare and chronic condition led to participants feeling isolated and stigmatised by health care services and their communities. Participants were able to overcome this challenge to their identities through the use of social support, particularly from other people with dystonia. Recommendations for reducing the stigmatising experiences of people with dystonia can help to ease the process of adjustment to the illness and enable people to pursue meaningful lives and positive identities. Recommendations for research are aimed at increasing knowledge about these processes.IMPLICATIONS FOR REHABILITATIONDystonia has a pervasive, negative impact on the lives of people with the condition.The struggle for diagnosis marks the beginning of a period of psychological adjustment, the difficulty of which is compounded by social isolation and stigma.Support groups and peer interaction help people to integrate dystonia into their concept of a meaningful life and identity.Health professionals should play a pivotal role in assisting patients during the process of adjustment and on-going self-management through sensitive communication and signposting to wider support services.
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Affiliation(s)
- Andrew Morgan
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Pete Greasley
- Division of Health Research, Lancaster University, Lancaster, UK
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13
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Jankovic J, Truong D, Patel AT, Brashear A, Evatt M, Rubio RG, Oh CK, Snyder D, Shears G, Comella C. Injectable DaxibotulinumtoxinA in Cervical Dystonia: A Phase 2 Dose-Escalation Multicenter Study. Mov Disord Clin Pract 2018; 5:273-282. [PMID: 30009213 PMCID: PMC6032882 DOI: 10.1002/mdc3.12613] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 02/06/2018] [Indexed: 01/25/2023] Open
Abstract
Background Injectable daxibotulinumtoxinA (an investigational botulinum toxin, RT002) may offer a more prolonged duration of response—and therefore less frequent dosing—than onabotulinumtoxinA. Objectives To perform a phase 2, open‐label, dose‐escalation study to assess the efficacy and safety of daxibotulinumtoxinA in cervical dystonia. Methods Subjects with moderate‐to‐severe isolated cervical dystonia were enrolled in sequential cohorts to receive a single open‐label, intramuscular dose of injectable daxibotulinumtoxinA of up to 200 U (n = 12), 200–300 U (n = 12), or 300–450 U (n = 13; https://clinicaltrials.gov identifier NCT02706795). Results Overall, 33/37 enrollees completed the trial. DaxibotulinumtoxinA was associated with mean reductions in Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)‐Total score of 16.8 (38%) at week 4, 21.3 (50%) at week 6, and 12.8 (30%) at week 24. The proportion of subjects who were responders (achieved ≥ 20% reduction in TWSTRS‐Total score) was 94% at week 6 and 68% at week 24. The median duration of response (time until > 20% of the improvement in TWSTRS‐Total score achieved at week 4 was no longer retained or re‐treatment was needed) was 25.3 weeks (95% CI, 20.14–26.14 weeks). There were no serious adverse events and there was no apparent dose‐related increase in the incidence of adverse events. The most common treatment‐related adverse events were dysphagia (14%) and injection site erythema (8%). Conclusions Preliminary assessments suggest that injectable daxibotulinumtoxinA at doses up to 450 U is well tolerated and may offer prolonged efficacy in the treatment of cervical dystonia. Further studies involving larger numbers of patients are now warranted.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic Department of Neurology, Baylor College of Medicine Houston TX
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute Fountain Valley CA
| | - Atul T Patel
- Kansas City Bone & Joint Clinic Overland Park KS
| | | | - Marian Evatt
- Acting Chief, Neurology Department of Veterans Affairs Medical Center, Atlanta, GA and Department of Neurology Emory University Atlanta GA
| | | | - Chad K Oh
- Revance Therapeutics, Inc. Newark CA
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Wissel J. Towards flexible and tailored botulinum neurotoxin dosing regimens for focal dystonia and spasticity - Insights from recent studies. Toxicon 2018; 147:100-106. [PMID: 29407165 DOI: 10.1016/j.toxicon.2018.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/27/2017] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
Botulinum neurotoxin (BoNT) is an effective, well-tolerated, and well-established option for the treatment of dystonic and spastic movement disorders. However, a single approach does not suit all patients, even within one disease indication. The degree of flexibility in treatment protocols is determined by individual product licenses, which often lag behind real-world clinical experience. A number of patient/practitioner surveys conducted recently have highlighted a desire for greater flexibility than that currently approved, both in BoNT doses and in the intervals between consecutive doses. New evidence arising from research conducted during the last few years has opened new avenues for tailoring BoNT treatment to patients' needs. Data suggest that escalating incobotulinumtoxinA doses enables treatment of a greater number of spasticity patterns than current dose limitations allow, without compromising safety or tolerability. Similarly, in patients with cervical dystonia (CD), repeated injections of incobotulinumtoxinA at intervals as early as 6 weeks after a previous treatment, based on individual patient need, were effective and well tolerated. Here, the BoNT doses and dosing intervals currently indicated in the USA and European Union are reviewed, together with the use of BoNT for the treatment of spasticity, CD, and blepharospasm. Opportunities for tailored BoNT therapy are also discussed.
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Affiliation(s)
- Jörg Wissel
- Department of Neurorehabilitation and Physical Therapy, Department of Neurology, Vivantes Hospital Spandau, Neue Bergstraße, 13585 Berlin, Germany.
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15
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Leplow B, Eggebrecht A, Pohl J. Treatment satisfaction with botulinum toxin: a comparison between blepharospasm and cervical dystonia. Patient Prefer Adherence 2017; 11:1555-1563. [PMID: 29066869 PMCID: PMC5605128 DOI: 10.2147/ppa.s141060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Differential effects of botulinum toxin (BoNT) treatment in cervical dystonia (CD) and blepharospasm (BSP) treatment satisfaction and emotional responses to a life with a disabling condition were investigated. Special interest was drawn to the course within a BoNT treatment cycle and the effects of subjective well-being vs perceived intensity of motor symptoms and quality of life. METHODS A questionnaire was distributed among 372 CD patients and 125 BSP patients, recruited from 13 BoNT centers throughout Germany. Items were related to dystonic symptoms, BoNT treatment responses and treatment satisfaction, quality of life, working situation, and emotional reactions to a life with dystonia. RESULTS CD patients and BSP patients were widely satisfied with BoNT treatment, but treatment satisfaction worsened significantly within the treatment cycle. Especially CD patients reported that both the dystonic symptoms and the effects of BoNT treatment were influenced by emotional factors. Despite good overall treatment effects, patients from both groups perceived marked persistence of motor symptoms, restrictions of everyday life functions, and reduced quality of life. Functional amelioration of motor symptoms and emotional well-being were only moderately correlated. About 22% of patients from both groups reported mental disorders or emotional disturbances prior to the onset of dystonia. CONCLUSION As numerous psychological factors determine perceived outcome, BoNT treatment should be further improved by patient's education strategies enhancing behavioral self-control. From the patient's perspective, individual intervals, which may avoid exacerbation between injection points, should be considered. Moreover, patients at risk, with reduced adherence and poor BoNT outcome, should be identified and addressed within psychoeducation.
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Affiliation(s)
- Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Correspondence: Bernd Leplow, Department of Psychology, Emil-Abderhalden-Str. 26–27, Martin-Luther-University Halle-Wittenberg, 06099 Halle (Saale), Germany, Tel +49 345 552 4358, Fax +49 345 552 7218, Email
| | - Anna Eggebrecht
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Johannes Pohl
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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