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脑瘫儿童/青少年痉挛相关疼痛。第 2 部分:汇总分析显示,注射用依库珠单抗毒素 A 的疗效。

Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled analysis.

机构信息

Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany.

Faculty of Medicine and Dentistry and University Hospital, Palacký University Olomouc, Olomouc, Czech Republic.

出版信息

J Pediatr Rehabil Med. 2023;16(1):83-98. doi: 10.3233/PRM-220020.

Abstract

PURPOSE

This pooled analysis of data from three Phase 3 studies investigated the effects of incobotulinumtoxinA on spasticity-related pain (SRP) in children/adolescents with uni-/bilateral cerebral palsy (CP).

METHODS

Children/adolescents (ambulant and non-ambulant) were evaluated for SRP on increasingly difficult activities/tasks 4 weeks after each of four incobotulinumtoxinA injection cycles (ICs) using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to lower limb [LL] or upper limb [UL] spasticity and respondent type [child/adolescent, interviewer, or parent/caregiver]). IncobotulinumtoxinA doses were personalized, with all doses pooled for analysis.

RESULTS

QPS key item responses were available from 331 and 155 children/adolescents with LL- and UL-spasticity, respectively, and 841/444 (LL/UL) of their parents/caregivers. IncobotulinumtoxinA efficacy was evident with the first IC. Efficacy was sustained and became more robust with further subsequent ICs. By Week 4 of the last (i.e. fourth) IC, 33.8-53.3% of children/adolescents reported complete SRP relief from their baseline pain for respective QPS items. Children/adolescents reported reductions in mean LL SRP intensity at levels that surpassed clinically meaningful thresholds. Similarly, parents/caregivers observed complete SRP relief and less frequent SRP with incobotulinumtoxinA. Similar results were found for UL SRP.

CONCLUSION

These findings indicate that incobotulinumtoxinA could bring considerable benefit to children/adolescents with spasticity by reducing SRP, even during strenuous activities.

摘要

目的

本汇总分析纳入三项 3 期研究的数据,旨在评估丁丙诺啡毒素 A 对单侧或双侧脑瘫患儿/青少年痉挛相关疼痛(SRP)的影响。

方法

在四项丁丙诺啡毒素 A 注射周期(IC)后 4 周,对能行走和不能行走的患儿/青少年进行评估,使用痉挛相关疼痛问卷(QPS;针对下肢 [LL] 或上肢 [UL] 痉挛且应答者类型(患儿/青少年、调查者或父母/照护者)的六个特定模块)评估越来越困难的活动/任务中的 SRP。根据患者的具体情况制定丁丙诺啡毒素 A 剂量,所有剂量汇总进行分析。

结果

331 例和 155 例具有 LL 和 UL 痉挛的患儿/青少年,以及 841/444 例(LL/UL)的父母/照护者提供了 QPS 关键项目应答。首次 IC 时即观察到丁丙诺啡毒素 A 的疗效。随着进一步后续 IC 的应用,疗效得以维持并变得更加强劲。在最后(即第四次)IC 的第 4 周,33.8%-53.3%的患儿/青少年报告其 QPS 各项均完全缓解基线疼痛。患儿/青少年报告其 LL 平均 SRP 强度降低至超过临床有意义的阈值水平。同样,父母/照护者观察到丁丙诺啡毒素 A 能完全缓解 SRP 且 SRP 发作频率降低。UL SRP 也观察到相似的结果。

结论

这些结果表明,丁丙诺啡毒素 A 可通过降低 SRP 为痉挛患儿/青少年带来显著获益,甚至在剧烈活动期间也如此。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ddb/10116134/09774ce957d0/prm-16-prm220020-g001.jpg

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