Abstract
Botulinum toxin type B (BoNT/B) has been recommended as an alternative for patients who have become resistant to botulinum toxin type A (BoNT/A). This study aimed to compare the clinical effect, within a patient, of four injections with low doses of rimabotulinumtoxinB with the effect of the preceding abobotulinumtoxinA (aboBoNT/A) injections. In 17 patients with cervical dystonia (CD) who had become resistant to aboBoNT/A, the clinical effect of the first four rimabotulinumtoxinB (rimaBoNT/B) injections was compared to the effect of the first four aboBoNT/A injections using a global assessment scale and the TSUI score. After the first two BoNT/B injections, all 17 patients responded well and to a similar extent as to the first two BoNT/A injections, but with more side effects such as dry mouth and constipation. After the next BoNT/B injection, the improvement started to decline. The response to the fourth BoNT/B injection was significant (p < 0.048) lower than the fourth BoNT/A injection. Only three patients developed a complete secondary treatment failure (CSTF) and five patients a partial secondary treatment failure (PSTF) after four BoNT/B injections. In nine patients, the usual response persisted. With the use of low rimaBoNT/B doses, the induction of CSTF and PSTF to BoNT/B could not be avoided but was delayed in comparison to the use of higher doses. In contrast to aboBoNT/A injections, PSTF and CSTF occurred much earlier, although low doses of rimaBoNT/B had been applied.
Highlights
Since the first clinical application of botulinum neurotoxin type A (BoNT/A) to correct extraocular muscle dysbalance as an alternative to strabismus surgery by Scott in 1979 [1], injections of BoNT/A have become the treatment of choice for a variety of focal dystonia [2,3]
BoNT/A and Botulinum toxin type B (BoNT/B) injections (Figure 2A) and the similarity of the distributions of the relative improvement after 6 months of BoNT/A or BoNT/B treatment (Figure 3) no significant correlation was found when the response of a single patient to a BoNT/A injection was correlated with his response to the corresponding BoNT/B injection
Discussion after 6 months of BoNT/A or BoNT/B treatment (Figure 3) no significant correlation was improvement found when the response of a single patient to a BoNT/A injection was correlated with his response to
Summary
Since the first clinical application of botulinum neurotoxin type A (BoNT/A) to correct extraocular muscle dysbalance as an alternative to strabismus surgery by Scott in 1979 [1], injections of BoNT/A have become the treatment of choice for a variety of focal dystonia [2,3]. Toxins 2020, 12, 677 of the protein content by a factor 5–6 to 5 ng/vial per 100 MU (summary of product characteristics (SPC) revised: 7/2020) and a neurotoxin protein load of 0.73 ng per 100 U [7]. This preparation has a more than five to six-fold lower risk of antibody formation of about 1.2% [5]. Even for this new onaBoNT/A preparation, the incidence of NABs is not zero. For the abobotulinumtoxinA preparation (aboBoNT/A; Dysport® ; Ipsen) with a comparable neurotoxin protein load of 0.65 ng/100 U [7]
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