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1346 - Secondary treatment failure with abobotulinumtoxinA, incobotulinumtoxinA and onabotulinumtoxinA: A systematic review and meta-analysis

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Co-Author(s)

  • UW

    Uwe Walter, MD

    Clinic Director
    Department of Neurology, Rostock University Medical Center
    Rostock, Mecklenburg-Vorpommern, Germany

  • PA

    Philipp Albrecht, MD

    Professor of Neurology
    Department of Neurology, Medical Faculty and University Hospital, Heinrich-Heine-University
    Dusseldorf, Nordrhein-Westfalen, Germany

    • Presenting Author(s)

  • WC

    Warner W. Carr, MD

    Physician
    Allergy & Asthma Associates of Southern California
    Mission Viejo, California, United States

    • Co-Author(s)

  • HH

    Harald Hefter, MD

    Professor
    Medical Faculty and University Hospital, Heinrich-Heine-University
    Dusseldorf, Nordrhein-Westfalen, Germany

Objectives: Botulinum neurotoxin A (BoNT-A) is recommended for the treatment of cervical dystonia (CD) and spasticity, but since these are biologicals, some patients can develop neutralising antibodies against BoNT-A during treatment, which may result in reduced efficacy and, in some cases, secondary treatment failure (STF). The aim of this meta-analysis was to investigate the incidence of STF after treatment with each of three commercially-available BoNT-A formulations for which long-term data have been published.

Design: A systematic review was conducted. Identified publications reporting neutralising antibody-induced STF after first-line treatment with abobotulinumtoxinA, incobotulinumtoxinA or onabotulinumtoxinA (excluding original formulation) in patients with CD or spasticity underwent meta-analysis. Occurrence of STF was determined using the DerSimonian-Laird random-effects method, with the Freeman-Tukey double arcsine transformation performed before analysis. The difference in occurrence of STF between the three formulations was assessed by the significance of the test for heterogeneity between groups.

Results: A total of 19 studies were identified that assessed STF in CD or spasticity. Meta-analysis showed that the proportions of patients with CD developing STF were significantly higher after treatment with abobotulinumtoxinA (7%; p=0.005) or onabotulinumtoxinA (2%; p=0.04) than with incobotulinumtoxinA (0%). There was no difference between the proportions of patients developing STF after treatment with abobotulinumtoxinA versus onabotulinumtoxinA (p=0.18). The proportion of patients with spasticity developing STF after treatment with abobotulinumtoxinA (5%; p=0.01) was also significantly higher than with incobotulinumtoxinA (0%). No patients treated exclusively with incobotulinumtoxinA developed neutralising antibody-induced STF, irrespective of the treatment indication.

Conclusions:

Our meta-analysis found that incobotulinumtoxinA was associated with a significantly lower risk of developing STF compared with abobotulinumtoxinA (CD and spasticity) and onabotulinumtoxinA (CD). IncobotulinumtoxinA is recommended to avoid developing neutralising antibody-induced STF, particularly for patients who require higher doses and repeated treatments.