OnabotulinumtoxinA Treatment of Upper Limb Spasticity: Analysis of US Practice Patterns From the ASPIRE Study

Abstract

<h3>Research Objectives</h3> To examine onabotulinumtoxinA (onabotA) utilization patterns within 8 additional muscle groups consistent with updated US label in patients with upper limb (UL) spasticity from the Adult Spasticity International Registry (ASPIRE) study over a 2-year period1-6. <h3>Design</h3> Multicenter, prospective, observational study (NCT01930786). <h3>Setting</h3> US clinical sites. <h3>Participants</h3> Adult patients who received onabotA to UL muscles for spasticity. <h3>Interventions</h3> Total onabotA dose ≤400 U per treatment session consistent with US label. <h3>Main Outcome Measures</h3> OnabotA treatment utilization. <h3>Results</h3> Of 443 US patients, 336 had UL spasticity, 45 of whom received ≤400 U onabotA injections in selected muscles consistent with the newly approved label. Mean age (SD) was 51.3 (16.0) years, 26 (58%) were male, and 23 (51%) were onabotA-naive. Postures treated included clenched fist (71.1%), flexed wrist (55.6%), flexed elbow (73.3%), thumb in palm (20.0%), intrinsic plus hand (20.0%), and pronated forearm (31.1%). Treated postures presenting in patients who received onabotA injections only in muscles consistent with label before July 2021 included clenched fist (93.8%), flexed wrist (100%), flexed elbow (12.1%), and thumb in palm (33.3%). Treated postures in patients who received onabotA injections in muscles consistent with the expanded label in July 2021 included clenched fist (100%), flexed wrist (100%), flexed elbow (100%), thumb in palm (100%), intrinsic plus hand (100%), and pronated forearm (100%). The majority of patients (80.0%) had >1 abnormal posture. Of 38 adverse events (AEs), 1 treatment-related AE (muscular weakness) and no treatment-related serious AEs were reported. <h3>Conclusions</h3> This ASPIRE post hoc analysis provides real-world evidence of the opportunity to educate on the expanded label for onabotA, highlighting elbow, forearm, and finger postures and the ability to treat, on-label, multiple UL postures more holistically. <h3>Author(s) Disclosures</h3> GEF: Consultant for, research grants from Allergan (an AbbVie company), Ipsen, Merz. WF: Research grants: NIH. MCM: Research support: AbbVie, Merz; Advisory board: Ipsen, Pacira. KN: Nothing to report. M Schwartz: Biostatistical consultant: Allergan (an AbbVie company). M Sadeghi, AZ: Employee: AbbVie. AE: Consultant: Allergan (an AbbVie company), Ipsen, Merz; Research grants: Allergan (an AbbVie company), Ipsen.