Samotus Olivia, Jog Mandar
Department of Clinical Neurological Sciences London Health Sciences Centre-Lawson Health Research Institute London Ontario Canada.
Schulich School of Medicine and Dentistry University of Western London Ontario Canada.
Mov Disord Clin Pract. 2023 Mar 1;10(5):756-763. doi: 10.1002/mdc3.13696. eCollection 2023 May.
Symptom re-emergence before re-injection negatively impacts cervical dystonia (CD) patients receiving botulinum toxin type A (BoNT-A) therapy. Longer waning time is associated with abobotulinumtoxinA (abo-BoNT-A) as compared to onabotulinumtoxinA (ona-BoNT-A)/incobotulinumtoxinA (inco-BoNT-A) formulations.
To compare waning time and treatment outcomes when chronically injected CD patients experiencing early waning despite being optimized on BoNT-A (ona-BoNT-A/inco-BoNT-A) were converted to abo-BoNT-A.
Thirty-three chronically injected CD participants with a waning time of ≤8 weeks were converted to abo-BoNT-A (1:2.5 dose ratio) for three injections every 12-weeks. The second and third injection patterns were kinematically optimized. Participants were converted back to their original BoNT-A for the fourth injection (1:2.5) using the same third abo-BoNT-A pattern. Participant-perceived waning times were collected post-injections. Clinical scales (Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS)) and kinematic measures were collected 12-weeks post-injection and at three peak effect time-points.
Compared to baseline, waning time (12-22 days) significantly increased following all abo-BoNT-A treatments ( < 0.005) but was not significantly different at the fourth injection (original BoNT-A reconversion). TWSTRS sub-scores significantly reduced following all abo-BoNT-A treatments ( < 0.0001) and at peak effect following the third injection compared to original BoNT-A. Dysphagia and muscle weakness were reported and comparable to safety of original BoNT-A formulations.
Optimized patients experiencing waning had significant improvement in the peak benefit as well as the duration of effect when converted to abo-BoNT-A. This effect was toxin dependent as reconversion to the original BoNT-A using the kinematically optimized pattern failed to produce an improvement in waning.
再次注射前症状复发对接受A型肉毒毒素（BoNT-A）治疗的颈部肌张力障碍（CD）患者产生负面影响。与onabotulinumtoxinA（ona-BoNT-A）/incobotulinumtoxinA（inco-BoNT-A）制剂相比，阿柏西普肉毒毒素A（abo-BoNT-A）的药效消退时间更长。
比较尽管在BoNT-A（ona-BoNT-A/inco-BoNT-A）治疗下仍出现早期药效消退的慢性注射型CD患者转换为abo-BoNT-A后的药效消退时间和治疗效果。
33名慢性注射型CD参与者，其药效消退时间≤8周，转换为abo-BoNT-A（1:2.5剂量比），每12周注射三次。第二和第三次注射模式在运动学上进行了优化。第四次注射（1:2.5）时，参与者恢复使用原来的BoNT-A，采用与第三次abo-BoNT-A相同的模式。注射后收集参与者感知的药效消退时间。在注射后12周和三个峰值效应时间点收集临床量表（多伦多西部痉挛性斜颈评定量表（TWSTRS））和运动学指标。
与基线相比，所有abo-BoNT-A治疗后药效消退时间（12 - 22天）显著延长（<0.005），但第四次注射（恢复使用原来的BoNT-A）时无显著差异。所有abo-BoNT-A治疗后TWSTRS子评分显著降低（<0.0001），与原来的BoNT-A相比，第三次注射后的峰值效应时也显著降低。报告了吞咽困难和肌肉无力情况，且与原来的BoNT-A制剂安全性相当。
经历药效消退的优化患者转换为abo-BoNT-A后，峰值效益和疗效持续时间有显著改善。这种效果依赖于毒素，因为采用运动学优化模式恢复使用原来的BoNT-A未能改善药效消退情况。
