Treating Upper Limb Spasticity With OnabotulinumtoxinA: Subgroup Analysis of US Practice Patterns From the ASPIRE Study (P12-8.012)

Abstract

<h3>Objective:</h3> To examine onabotulinumtoxinA (onabotA) treatment utilization patterns in the United States (US) for pronated forearm and intrinsic plus hand postures in patients with upper limb (UL) spasticity over a 2-year period. <h3>Background:</h3> In 2021, onabotA received approval in US for injection into 8 additional muscles in the treatment of adult UL spasticity including muscles of the elbow and forearm (brachialis, brachioradialis, pronator teres, and pronator quadratus), as well as intrinsic hand muscles (lumbricals and interossei) and thumb muscles (flexor pollicis brevis and opponens pollicis). More information is required to maximize effectiveness in patients with UL spasticity. <h3>Design/Methods:</h3> This post hoc analysis utilized US data from the multicenter, prospective, observational Adult Spasticity International Registry (ASPIRE) study (NCT01930786) which ran from 2013 through 2017. Participants were adult patients who received onabotA (total dose ≤400 U per treatment session) to UL muscles for spasticity. This analysis was centered on 2021 onabotA expanded label and evaluated treatment utilization for pronated forearm and intrinsic plus hand postures in patients with UL spasticity to determine educational opportunities for optimized treatment in the real-world setting. <h3>Results:</h3> Of 316 US patients in ASPIRE treated for UL spasticity, 135/316 (43%) had pronated forearm and 89/316 (28%) had intrinsic plus hand postures. OnabotA (≤400 U) treatment was delivered to select UL muscles of 45 patients consistent with expanded US label. Baseline characteristics of these 45 patients included a mean age (SD) of 51.3 (16.0) years, 23/45(51%) who were onabotA-naive, and 26/45 (58%) were male. New postures treated included intrinsic plus hand (9/45; 20.0%) and pronated forearm(14/45;31.1%). Of the 36 adverse events (AEs) that occurred, 1 was treatment-related (muscular weakness); no treatment-related serious AEs were reported. <h3>Conclusions:</h3> This analysis provides real-world evidence of the opportunity to educate on the treatment of pronated forearm and intrinsic plus hand postures in accordance with the expanded label for onabotA. <b>Disclosure:</b> Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Allergan. Gerard Francisco has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Saol. Gerard Francisco has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Gerard Francisco has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ekso. Gerard Francisco has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sword Health. Gerard Francisco has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Journal of ISPRM. The institution of Gerard Francisco has received research support from Allergan. The institution of Gerard Francisco has received research support from Merz. The institution of Gerard Francisco has received research support from Ipsen. The institution of Gerard Francisco has received research support from Revance. Gerard Francisco has a non-compensated relationship as a Director with American Board of PM&amp;R that is relevant to AAN interests or activities. Gerard Francisco has a non-compensated relationship as a Vice-Presdent with International Society of Physical and Rehabilitation Medicine that is relevant to AAN interests or activities. Dr. Feng has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for HuaMed Tech. Dr. Feng has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Precision Neuroscience. Dr. Feng has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Namsa. The institution of Dr. Feng has received research support from NIH. The institution of Dr. Feng has received research support from American heart association . Michael C Munin, 25482 has received personal compensation for serving as an employee of Pacira. Michael C Munin, 25482 has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merz. Dr. Ngo has nothing to disclose. Marc Schwartz has nothing to disclose. Dr. Sadeghi has received personal compensation for serving as an employee of AbbVie. Dr. Sadeghi has stock in Abbvie/Abbott. Dr. Zuzek has received personal compensation for serving as an employee of AbbVie Inc.. Dr. Zuzek has stock in AbbVie Inc.. Dr. Esquenazi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ipsen and Allergan. Dr. Esquenazi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ipsen and Allergan. The institution of Dr. Esquenazi has received research support from Ipsen, Allergan and Merz.