Exploring Oral Skeletal Muscle Relaxant Therapy in Adult Poststroke Patients in the US
Author(s)
Jonathan Bouchard, MS, RPh, Seth Goldfarb, MS, Amandeep Mann, PhD;
Ipsen, Cambridge, MA, USA
Ipsen, Cambridge, MA, USA
Presentation Documents
OBJECTIVES: Poststroke spasticity (PSS) occurs in ~25-43% of patients within 2-12 weeks following a stroke. Oral skeletal muscle relaxants (OSMRs) are a recognized treatment option for PSS; however, limited real‑world evidence is available. We examined pharmacological treatment dynamics of OSMR therapy poststroke in adults following hospitalization over a 2-year follow-up.
METHODS: Claims from the Merative MarketScan® database of commercially/self-insured members (10/01/2015-06/30/2023) were analyzed. Eligible patients had an ICD-10 diagnosis code for stroke requiring inpatient stay (index date) with 12 months of continuous enrollment with medical/pharmacy benefits before index (pre-index) and 36 months after index (post-index). Patients with prior stroke, spasticity, OSMR, intrathecal baclofen, or botulinum toxins were excluded. OSMR pharmacotherapy was defined as an OSMR prescription fill within 1 year of index. Persistence (time to discontinuation from OSMR initiation), adherence, and treatment patterns of OSMR, along with characteristics and healthcare utilization among patients with OSMR vs no PSS treatment, were examined.
RESULTS: Overall, 13,306 patients fulfilled study criteria. 360 (2.7%) patients initiated OSMR pharmacotherapy within 1 year of index, with a mean±SD time of initiation of 119.7±106.6 days. Persistence (mean±SD) was 53.4 ±121.5 days. Adherence (mean±SD) was 54.9±33.9% (medication possession ratio) and 52.6±32.9% (percentage of days covered). 116 (32%) OSMR-treated patients restarted treatment following nonpersistence. 3 (0.8%) OSMR-treated patients progressed to botulinum toxin treatment. Median (IQR) overall healthcare costs were $65,105 ($92,877) and $43,197 ($65,414) for the OSMR-treated and no PSS treatment groups, respectively. Higher usage of opiates and NSAIDs was observed in the OSMR-treated group vs the no PSS treatment group (P<.001). Stepwise multivariate analysis revealed that prior anxiolytic use, lower age, and higher Charlson Comorbidity Index score pre-index were associated with OSMR initiation.
CONCLUSIONS: Results demonstrate low persistence and adherence to OSMRs, along with polypharmacy, which may worsen treatment outcomes. These findings highlight the need to optimize PSS management and reduce polypharmacy.
METHODS: Claims from the Merative MarketScan® database of commercially/self-insured members (10/01/2015-06/30/2023) were analyzed. Eligible patients had an ICD-10 diagnosis code for stroke requiring inpatient stay (index date) with 12 months of continuous enrollment with medical/pharmacy benefits before index (pre-index) and 36 months after index (post-index). Patients with prior stroke, spasticity, OSMR, intrathecal baclofen, or botulinum toxins were excluded. OSMR pharmacotherapy was defined as an OSMR prescription fill within 1 year of index. Persistence (time to discontinuation from OSMR initiation), adherence, and treatment patterns of OSMR, along with characteristics and healthcare utilization among patients with OSMR vs no PSS treatment, were examined.
RESULTS: Overall, 13,306 patients fulfilled study criteria. 360 (2.7%) patients initiated OSMR pharmacotherapy within 1 year of index, with a mean±SD time of initiation of 119.7±106.6 days. Persistence (mean±SD) was 53.4 ±121.5 days. Adherence (mean±SD) was 54.9±33.9% (medication possession ratio) and 52.6±32.9% (percentage of days covered). 116 (32%) OSMR-treated patients restarted treatment following nonpersistence. 3 (0.8%) OSMR-treated patients progressed to botulinum toxin treatment. Median (IQR) overall healthcare costs were $65,105 ($92,877) and $43,197 ($65,414) for the OSMR-treated and no PSS treatment groups, respectively. Higher usage of opiates and NSAIDs was observed in the OSMR-treated group vs the no PSS treatment group (P<.001). Stepwise multivariate analysis revealed that prior anxiolytic use, lower age, and higher Charlson Comorbidity Index score pre-index were associated with OSMR initiation.
CONCLUSIONS: Results demonstrate low persistence and adherence to OSMRs, along with polypharmacy, which may worsen treatment outcomes. These findings highlight the need to optimize PSS management and reduce polypharmacy.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD13
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)