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Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis
Botulinum toxin (BT) is an effective treatment for spasticity symptoms in multiple sclerosis (MS). Despite its wide use in clinical practices, only few studies have explored long-term persistence. We aim to evaluate the rate of discontinuation of BT treatment and the correlation with MS, spasticity,...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693315/ https://www.ncbi.nlm.nih.gov/pubmed/36356024 http://dx.doi.org/10.3390/toxins14110774 |
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author | Novarella, Federica Carotenuto, Antonio Cipullo, Paolo Iodice, Rosa Cassano, Emanuele Spiezia, Antonio Luca Capasso, Nicola Petracca, Maria Falco, Fabrizia Iacovazzo, Carmine Servillo, Giuseppe Lanzillo, Roberta Brescia Morra, Vincenzo Moccia, Marcello |
author_facet | Novarella, Federica Carotenuto, Antonio Cipullo, Paolo Iodice, Rosa Cassano, Emanuele Spiezia, Antonio Luca Capasso, Nicola Petracca, Maria Falco, Fabrizia Iacovazzo, Carmine Servillo, Giuseppe Lanzillo, Roberta Brescia Morra, Vincenzo Moccia, Marcello |
author_sort | Novarella, Federica |
collection | PubMed |
description | Botulinum toxin (BT) is an effective treatment for spasticity symptoms in multiple sclerosis (MS). Despite its wide use in clinical practices, only few studies have explored long-term persistence. We aim to evaluate the rate of discontinuation of BT treatment and the correlation with MS, spasticity, and injection variables. This retrospective study on 3-year prospectively collected data included 122 MS patients receiving BT injections for spasticity. We collected MS clinical variables (disease durations, Expanded Disability Status Scales [EDSSs], disease-modifying treatments [DMT], and Symbol Digit Modalities Tests [SDMTs]), modified Ashworth scales [MASs], concomitant treatments, and injection variables (formulation, dose, number of injections, and intervals between injections). A total of 14 out of the 122 patients discontinued BT after a mean time of 3.0 ± 1.5 years. In the Cox regression model including the MS clinical variables, the probability of BT discontinuations increased in patients with DMT changes during follow-ups (HR = 6.34; 95%Cl = 2.47, 18.08; p < 0.01) and with impaired SDMTs (HR = 1.20; 95%Cl = 1.04, 1.96; p < 0.01). In the model including the spasticity variables, there were no associations between BT discontinuation and MAS or other spasticity treatments. In the model including the injection variables, the probability of discontinuation decreased by 80% for each cumulative injection (HR = 0.16; 95%Cl = 0.05, 0.45; p < 0.01), but increased by 1% for each additional day over the 3-month interval between injections (HR = 1.27; 95%Cl = 1.07, 1.83; p < 0.01). BT discontinuation was associated with concomitant MS-related issues (e.g., treatment failure and DMT change) and the presence of cognitive impairment, which should be accounted for when planning injections. The interval between injections should be kept as short as possible from regulatory and clinical perspectives to maximize the response across all of the spasticity symptoms and to reduce discontinuation in the long term. |
format | Online Article Text |
id | pubmed-9693315 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96933152022-11-26 Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis Novarella, Federica Carotenuto, Antonio Cipullo, Paolo Iodice, Rosa Cassano, Emanuele Spiezia, Antonio Luca Capasso, Nicola Petracca, Maria Falco, Fabrizia Iacovazzo, Carmine Servillo, Giuseppe Lanzillo, Roberta Brescia Morra, Vincenzo Moccia, Marcello Toxins (Basel) Article Botulinum toxin (BT) is an effective treatment for spasticity symptoms in multiple sclerosis (MS). Despite its wide use in clinical practices, only few studies have explored long-term persistence. We aim to evaluate the rate of discontinuation of BT treatment and the correlation with MS, spasticity, and injection variables. This retrospective study on 3-year prospectively collected data included 122 MS patients receiving BT injections for spasticity. We collected MS clinical variables (disease durations, Expanded Disability Status Scales [EDSSs], disease-modifying treatments [DMT], and Symbol Digit Modalities Tests [SDMTs]), modified Ashworth scales [MASs], concomitant treatments, and injection variables (formulation, dose, number of injections, and intervals between injections). A total of 14 out of the 122 patients discontinued BT after a mean time of 3.0 ± 1.5 years. In the Cox regression model including the MS clinical variables, the probability of BT discontinuations increased in patients with DMT changes during follow-ups (HR = 6.34; 95%Cl = 2.47, 18.08; p < 0.01) and with impaired SDMTs (HR = 1.20; 95%Cl = 1.04, 1.96; p < 0.01). In the model including the spasticity variables, there were no associations between BT discontinuation and MAS or other spasticity treatments. In the model including the injection variables, the probability of discontinuation decreased by 80% for each cumulative injection (HR = 0.16; 95%Cl = 0.05, 0.45; p < 0.01), but increased by 1% for each additional day over the 3-month interval between injections (HR = 1.27; 95%Cl = 1.07, 1.83; p < 0.01). BT discontinuation was associated with concomitant MS-related issues (e.g., treatment failure and DMT change) and the presence of cognitive impairment, which should be accounted for when planning injections. The interval between injections should be kept as short as possible from regulatory and clinical perspectives to maximize the response across all of the spasticity symptoms and to reduce discontinuation in the long term. MDPI 2022-11-09 /pmc/articles/PMC9693315/ /pubmed/36356024 http://dx.doi.org/10.3390/toxins14110774 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Novarella, Federica Carotenuto, Antonio Cipullo, Paolo Iodice, Rosa Cassano, Emanuele Spiezia, Antonio Luca Capasso, Nicola Petracca, Maria Falco, Fabrizia Iacovazzo, Carmine Servillo, Giuseppe Lanzillo, Roberta Brescia Morra, Vincenzo Moccia, Marcello Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title | Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title_full | Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title_fullStr | Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title_full_unstemmed | Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title_short | Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis |
title_sort | persistence with botulinum toxin treatment for spasticity symptoms in multiple sclerosis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693315/ https://www.ncbi.nlm.nih.gov/pubmed/36356024 http://dx.doi.org/10.3390/toxins14110774 |
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