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1303 - A systematic review and meta-analysis of neutralizing antibodies after treatment with abobotulinumtoxinA, incobotulinumtoxinA and onabotulinumtoxinA across multiple indications

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

WC

Warner W. Carr, MD

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

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
HH

Harald Hefter, MD

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

Objectives: Botulinum neurotoxin A (BoNT-A) is a biologic treatment recommended for the treatment of cervical dystonia (CD), spasticity, and blepharospasm. The biological nature of BoNT-A means some patients can develop neutralising antibodies (NAbs) against BoNT-A during treatment, which may result in reduced efficacy and, in some cases, secondary treatment failure. This meta-analysis investigated the incidence of NAb-positivity after treatment with one of three commercially-available BoNT-A formulations.

Design: A systematic review was conducted in April 2024, and meta-analysis was performed of publications reporting data on immunogenicity after first-line treatment with abobotulinumtoxinA, incobotulinumtoxinA or onabotulinumtoxinA (excluding original formulation) in patients with CD, spasticity or blepharospasm.

Results: A total of 29 publications reporting 28 unique studies that assessed NAb-positivity in the three indications were identified. Three studies were identified assessing NAb positivity in blepharospasm. The proportion of patients with CD developing NAbs was significantly higher after treatment with abobotulinumtoxinA (2.1%; p=0.02) versus incobotulinumtoxinA (0%). There was no difference between the proportion of patients testing positive for NAbs after treatment with onabotulinumtoxinA (1.5%) versus abobotulinumtoxinA (p=0.72) or incobotulinumtoxinA (p=0.07). The proportion of patients with spasticity developing NAbs after treatment with onabotulinumtoxinA (1.2%; p=0.01) was significantly higher than with incobotulinumtoxinA (0%). There was no difference between the proportions of patients developing NAbs after treatment with abobotulinumtoxinA (0.5%) versus onabotulinumtoxinA (p=0.84) or incobotulinumtoxinA (p=0.12). The proportion of patients with blepharospasm developing NAbs was significantly higher after abobotulinumtoxinA (16.7%) than onabotulinumtoxinA (0%; p< 0.001) or incobotulinumtoxinA (0%; p=0.002).

Conclusions: Our meta-analysis identified no patients exclusively treated with incobotulinumtoxinA that developed persistent NAbs, supporting the low antigenicity of this BoNT-A formulation. The potential cumulative exposure to different BoNT-A formulations for different indications is something that clinicians need to be increasingly aware of. Therefore, incobotulinumtoxinA may be recommended to avoid developing immunogenicity, particularly for patients who require higher doses and repeated treatments.