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Determinants of botulinum toxin discontinuation in multiple sclerosis: a retrospective study

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Abstract

The purpose of the present study was to investigate the long-term persistence to treatment with botulinum toxin type A (BoNT-A) for multiple sclerosis (MS)-related spasticity and the determinants of BoNT-A discontinuation in daily clinical setting. We retrospectively collected data of patients who started BoNT-A injections and underwent regular follow-up visits. Determinants of BoNT-A discontinuation were explored in a time-to-event Cox regression analysis which included as independent variables a large set of demographic and clinical characteristics. A total of 185 patients started BoNT-A injections from 2002 to 2014 and were followed up to September 2016. Of them, data on 121 were considered in our analysis. At follow-up, 53 (44%) patients were still on treatment and 68 (56%) patients discontinued BoNT-A after a median time of 1.2 years [interval 6 months to 7.4 years]. The reasons for discontinuation were loss of efficacy (n = 45), logistic problems or barriers to reach the structure (n = 16), and adverse events (n = 7). The absence of caregiver (hazard ratio = 1.69, p = 0.03) and lack of regular rehabilitation (hazard ratio = 1.78, p = 0.02) were two independent predictors for BoNT-A discontinuation. Our study confirms the beneficial effect of combining BoNT-A injections with rehabilitation and highlights the crucial role of caregivers for achieving better long-term outcomes in people with MS suffering from spasticity.

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Authors and Affiliations

  1. S. Andrea Hospital, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy

    Pamela Latino, Letizia Castelli, Maria Rita Marchetti, Carlo Pozzilli & Morena Giovannelli

  2. Department of Neurology and Psychiatry, Sapienza University, Viale dell’Università 30, 00185, Rome, Italy

    Luca Prosperini & Carlo Pozzilli

Authors
  1. Pamela Latino
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  2. Letizia Castelli
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  3. Luca Prosperini
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  4. Maria Rita Marchetti
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  5. Carlo Pozzilli
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  6. Morena Giovannelli
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Corresponding author

Correspondence to Luca Prosperini.

Ethics declarations

The present study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The ethical committee board of our university provided exemption of approval for non-interventional studies. Clinical data were prospectively collected and stored into an electronic database after obtaining an informed consent from each participant.

Conflict of interest

P.L. has no disclosures. L.C. received consulting fees from Almirall. L.P. received consulting fees from Biogen, Genzyme, and Novartis; speaking honoraria from Biogen, Genzyme, Merck Serono, Novartis, and Teva; travel grants from Biogen, Genzyme, and Teva; and research grants from Associazione Italiana Sclerosi Multipla and Genzyme. C.P. received consulting and/or lecture fees and/or research funding and travel grant from Almirall, Bayer Schering, Biogen, Genzyme, Merck Serono, Novartis, Roche, and Teva. M.R.M. has no disclosures. M.G. has no disclosures.

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Latino, P., Castelli, L., Prosperini, L. et al. Determinants of botulinum toxin discontinuation in multiple sclerosis: a retrospective study. Neurol Sci 38, 1841–1848 (2017). https://doi.org/10.1007/s10072-017-3078-3

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  • DOI: https://doi.org/10.1007/s10072-017-3078-3

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