Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment
Background: Recent studies of botulinum toxin for post-stroke spasticity indicate potential benefits of early treatment (i. e., first 6 months) in terms of developing hypertonicity, pain and passive function limitations. This non-interventional, longitudinal study aimed to assess the impact of disea...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2020.00104/full |
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| author | Jörg Wissel Klemens Fheodoroff Maurits Hoonhorst Martina Müngersdorf Philippe Gallien Niklaus Meier Jürgen Hamacher Harald Hefter Pascal Maisonobe Manuel Koch |
| author_facet | Jörg Wissel Klemens Fheodoroff Maurits Hoonhorst Martina Müngersdorf Philippe Gallien Niklaus Meier Jürgen Hamacher Harald Hefter Pascal Maisonobe Manuel Koch |
| author_sort | Jörg Wissel |
| collection | DOAJ |
| description | Background: Recent studies of botulinum toxin for post-stroke spasticity indicate potential benefits of early treatment (i. e., first 6 months) in terms of developing hypertonicity, pain and passive function limitations. This non-interventional, longitudinal study aimed to assess the impact of disease duration on the effectiveness of abobotulinumtoxinA treatment for upper limb spasticity.Methods: The early-BIRD study (NCT01840475) was conducted between February 2013 and 2018 in 43 centers across Germany, France, Austria, Netherlands and Switzerland. Adult patients with post-stroke upper limb spasticity undergoing routine abobotulinumtoxinA treatment were followed for up to four treatment cycles. Patients were categorized by time from stroke event to first botulinum toxin-A treatment in the study (as defined by the 1st and 3rd quartiles time distribution) into early-, medium- and late- start groups. We hypothesized that the early-start group would show a larger benefit (decrease) as assessed by the modified Ashworth scale (MAS, primary endpoint) on elbow plus wrist flexors compared with the late-start group.Results: Of the 303 patients enrolled, 292 (96.4%) received ≥1 treatment and 186 (61.4%) received 4 injection cycles and completed the study. Patients in all groups showed a reduction in MAS scores from baseline over the consecutive injection visits (i.e., at end of each cycle). Although reductions in MAS scores descriptively favored the early treatment group, the difference compared to the late group did not reach statistical significance at the last study visit (ANCOVA: difference in adjusted means of 0.15, p = 0.546).Conclusions: In this observational, routine-practice study, patients in all groups displayed a benefit from abobotulinumtoxinA treatment, supporting the effectiveness of treatment for patients at various disease stages. Although the data revealed some trends in favor of early vs. late treatment, we did not find strong evidence for a significant benefit of early vs. late start of treatment in terms of reduction in MAS scores. |
| first_indexed | 2024-12-19T08:14:53Z |
| format | Article |
| id | doaj.art-0b9dc3baf92f486f8af68b59b8ad14fa |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-19T08:14:53Z |
| publishDate | 2020-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-0b9dc3baf92f486f8af68b59b8ad14fa2022-12-21T20:29:32ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-02-011110.3389/fneur.2020.00104519083Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of TreatmentJörg Wissel0Klemens Fheodoroff1Maurits Hoonhorst2Martina Müngersdorf3Philippe Gallien4Niklaus Meier5Jürgen Hamacher6Harald Hefter7Pascal Maisonobe8Manuel Koch9Vivantes Hospital Spandau, Berlin, GermanyGailtal-Klinik, Hermagor-Pressegger See, AustriaCenter for Rehabilitation Vogellanden, Zwolle, NetherlandsNeurologisches Zentrum für Bewegungsstörungen und Diagnostik, Berlin, GermanyPôle Saint Hélier, Rennes, FranceDepartment of Neurology, University Hospital Bern and University of Bern, Bern, SwitzerlandPraxis für Neurochirurgie, Essen, GermanyDepartment of Neurology, University of Düsseldorf, Düsseldorf, GermanyIpsen Pharma, Boulogne-Billancourt, France0IPSEN PHARMA GmbH, Munich, GermanyBackground: Recent studies of botulinum toxin for post-stroke spasticity indicate potential benefits of early treatment (i. e., first 6 months) in terms of developing hypertonicity, pain and passive function limitations. This non-interventional, longitudinal study aimed to assess the impact of disease duration on the effectiveness of abobotulinumtoxinA treatment for upper limb spasticity.Methods: The early-BIRD study (NCT01840475) was conducted between February 2013 and 2018 in 43 centers across Germany, France, Austria, Netherlands and Switzerland. Adult patients with post-stroke upper limb spasticity undergoing routine abobotulinumtoxinA treatment were followed for up to four treatment cycles. Patients were categorized by time from stroke event to first botulinum toxin-A treatment in the study (as defined by the 1st and 3rd quartiles time distribution) into early-, medium- and late- start groups. We hypothesized that the early-start group would show a larger benefit (decrease) as assessed by the modified Ashworth scale (MAS, primary endpoint) on elbow plus wrist flexors compared with the late-start group.Results: Of the 303 patients enrolled, 292 (96.4%) received ≥1 treatment and 186 (61.4%) received 4 injection cycles and completed the study. Patients in all groups showed a reduction in MAS scores from baseline over the consecutive injection visits (i.e., at end of each cycle). Although reductions in MAS scores descriptively favored the early treatment group, the difference compared to the late group did not reach statistical significance at the last study visit (ANCOVA: difference in adjusted means of 0.15, p = 0.546).Conclusions: In this observational, routine-practice study, patients in all groups displayed a benefit from abobotulinumtoxinA treatment, supporting the effectiveness of treatment for patients at various disease stages. Although the data revealed some trends in favor of early vs. late treatment, we did not find strong evidence for a significant benefit of early vs. late start of treatment in terms of reduction in MAS scores.https://www.frontiersin.org/article/10.3389/fneur.2020.00104/fullabobotulinumtoxinAbotulinum toxinDysportspasticitystroke |
| spellingShingle | Jörg Wissel Klemens Fheodoroff Maurits Hoonhorst Martina Müngersdorf Philippe Gallien Niklaus Meier Jürgen Hamacher Harald Hefter Pascal Maisonobe Manuel Koch Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment Frontiers in Neurology abobotulinumtoxinA botulinum toxin Dysport spasticity stroke |
| title | Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment |
| title_full | Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment |
| title_fullStr | Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment |
| title_full_unstemmed | Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment |
| title_short | Effectiveness of AbobotulinumtoxinA in Post-stroke Upper Limb Spasticity in Relation to Timing of Treatment |
| title_sort | effectiveness of abobotulinumtoxina in post stroke upper limb spasticity in relation to timing of treatment |
| topic | abobotulinumtoxinA botulinum toxin Dysport spasticity stroke |
| url | https://www.frontiersin.org/article/10.3389/fneur.2020.00104/full |
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