7 research outputs found
Long-term efficacy of botulinum toxin A for treatment of blepharospasm,hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes
PURPOSE: To investigate the long-term effectiveness and safety of botulinum
neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial
spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation
index percentage' (BEI-%), in the dose-escalation evaluation. METHODS: All
patients in this multicentre study were followed for at least 10 years and main
outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and
frequency of adverse events. RESULTS: BEB, HFS, and EN patients received a mean
BoNT-A dose with a significant inter-group difference (P<0.0005, respectively).
The mean (+/-SD) effect duration was statistically different (P=0.009) among
three patient groups. Regarding the BoNT-A escalation indexes, the mean (+/-SD)
values of BEI-U and BEI-% were statistically different (P=0.035 and 0.047,
respectively) among the three groups. In BEB patients, the BEI-% was
significantly increased in younger compared with older patients (P=0.008). The
most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and
localized bruising. CONCLUSIONS: This long-term multicentre study supports a high
efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The
BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB
patients compared with HFS or EN patients and a significantly greater BEI-% in
younger vsolder BEB patients. These results confirm a greater efficacy in the
elderly and provide a framework for long-term studies with a more flexible and
reliable evaluation of drug-dose escalation
How satisfied are cervical dystonia patients after 3 years of botulinum toxin type A treatment? Results from a prospective, long-term observational study
Background Patients with cervical dystonia (CD) typically require regular injections of botulinum toxin to maintain symptomatic control. We aimed to document long-term patient satisfaction with CD symptom control in a large cohort of patients treated in routine practice. Methods This was a prospective, international, observational study (NCT01753349) following the course of adult CD treated with botulinum neurotoxin type A (BoNT-A) over 3 years. A comprehensive clinical assessment status was performed at each injection visit and subjects reported satisfaction in two ways: satisfaction with symptom control at peak effect and at the end of treatment cycle. Results Subject satisfaction remained relatively stable from the first to the last injection visit. At 3 years, 89.9% of subjects reported satisfaction with symptom control at peak effect and 55.6% reported satisfaction with symptom control at end of treatment cycle. By contrast, objective ratings of CD severity showed an overall reduction over 3 years. Meanâ±âSD Toronto Western Spasmodic Rating Scale (TWSTRS) Total scores (clinician assessed at end of treatment cycle) decreased from 31.59â±â13.04 at baseline to 24.49â±â12.43 at 3 years (meanâ±âSD reduction from baseline of â 6.97â±â11.56 points). Tsui scale scores also showed gradual improvement; the percent of subjects with a tremor component score of 4 reduced from 12.4% at baseline to 8.1% at 3 years. Conclusions Despite objective clinical improvements over 3 years, subject satisfaction with symptom control remained relatively constant, indicating that factors other than symptom control also play a role in patient satisfaction
INTEREST IN CD2, a global patient-centred study of long-term cervical dystonia treatment with botulinum toxin
Background: Longitudinal cohort studies provide important information about the clinical effectiveness of an intervention in the routine clinical setting, and are an opportunity to understand how a population presents for treatment and is managed. Methods: INTEREST IN CD2 (NCT01753349) is a prospective, international, 3-year, longitudinal, observational study following the course of adult idiopathic cervical dystonia (CD) treated with botulinum neurotoxin type A (BoNT-A). The primary objective is to document long-term patient satisfaction with BoNT-A treatment. Here we report baseline data. Results: This analysis includes 1036 subjects (67.4% of subjects were female; mean age was 54.7 years old; mean TWSTRS Total score was 31.7). BoNT-A injections were usually given in line with BoNT-A prescribing information. The most commonly injected muscles were splenius capitis (87.3%), sternocleidomastoid (82.6%), trapezius (64.3%), levator scapulae (40.9%) and semispinalis capitis (26.9%); 35.5% of subjects were injected using a guidance technique. Most subjects (87.8%) had been previously treated with BoNT-A (median interval between last pre-study injection and study baseline was 4 months); of these 84.8% reported satisfaction with BoNT-A treatment at peak effect during their previous treatment cycle and 51.5% remained satisfied at the end of the treatment. Analyses by geographical region revealed heterogeneity in the clinical characteristics and BoNT-A injection practice of CD subjects presenting for routine treatment. Conclusions: These baseline analyses provide sizeable data regarding the epidemiology and clinical presentation of CD, and demonstrate an international heterogeneity of clinical practice. Future longitudinal analyses of the full 3-year study will explore how these factors impact treatment satisfaction