Botulinum Toxin Therapy for Cervical Dystonia: The Science of Dosing

Tremor and Other Hyperkinetic Movements

article

Virgilio Gerald H. Evidente¹  Eric J. Pappert² 

[1] Movement Disorders Center of Arizona;Merz North America, Inc.Inc.

关键词: AbobotulinumtoxinA;    incobotulinumtoxinA;    onabotulinumtoxinA;    rimabotulinumtoxinB;    cervical dystonia;   

DOI  :  10.5334/tohm.185

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

The first-line treatment for cervical dystonia (CD) is botulinum toxin type A (BoNT-A), which has been established as a highly effective and well-tolerated therapy. However, this treatment is also complex and challenging to apply in clinical practice. Approximately 20% of patients discontinue therapy due to treatment failure, adverse effects, and other reasons. In addition, expert consensus recommendations are lacking to guide physicians in the optimal use of BoNT-A for CD. Among the issues still to be clarified is the optimal dosing frequency. The generally accepted standard for intervals between BoNT-A injections is ≥12 weeks; however, this standard is based primarily on the methodology of pivotal trials for the BoNT-A products, rather than on evidence that it is optimal in comparison to other intervals. While some retrospective, observational studies of BoNT-A used in clinical practice appear to support the use of ≥12-week dosing intervals, it is often unclear in these studies how the need for reinjection was determined. In contrast, a prospective dose-ranging trial in which patients were allowed to request reinjection as early as 8 weeks showed that about half of patients receiving abobotulinumtoxinA, at the currently recommended initial dose of 500 U, requested reinjection at 8 weeks. Moreover, results from an open-label, 68-week extension phase of the pivotal trial of incobotulinumtoxinA showed that 47.1% of patients had received reinjection at ≤12 weeks. Ongoing studies, such as the Cervical Dystonia Patient Registry for Observation of BOTOX® Efficacy (CD PROBE), may help clarify this question of optimal dosing intervals for BoNT-A in CD.

【 授权许可】

CC BY