OBJECTIVES: Effective limb spasticity (LS) treatment combines physiotherapy and BoNT-A. The North Staffordshire Rehabilitation Centre (UK) initiated LS patients on onabotulinumtoxinA (onaBoNT-A) prior to 2017; after, patients were initiated on abobotulinumtoxinA (aboBoNT-A). This study describes real-world outcomes of BoNT-A treatment, pre- and post-2017.

METHODS: This study assessed treatment outcomes with aboBoNT-A vs. onaBoNT-A in toxin-naïve adult LS patients. Assessments consisted of patients’ routine visits at 6 weeks(±2 weeks) and at 12 weeks(±4 weeks) after the first injection. Outcomes included Goal Attainment Scaling [GAS], patient satisfaction on a Likert scale, and cost per responder (based on response rate, average dose, and UK drug unit costs). Treatment response was defined as achievement or overachievement of all therapeutic goals.

RESULTS: Treatment groups had comparable demographic and clinical characteristics. In the aboBoNT-A group (N=54), 55.6% patients had lower limb (LL) spasticity, 35.2% upper limb (UL) spasticity, and 9.3% LL+UL spasticity. In the onaBoNT-A group (N=60), the split was 50.0%, 38.3%, and 11.7%, respectively. Mean doses of aboBoNT-A and onaBoNT-A were 718.8±410.7U and 194.8±87.9U in UL, and 689.7±449.9U and 186.4±97.9U in LL, respectively. In the overall population, doses of aboBoNT-A and onaBoNT-A were 753.7±457.3U and 206.0±98.8U. At Week 6, proportions of patients achieving or overachieving all therapeutic goals (GAS) were 56.4% [40.8%-72.0%] on aboBoNT-A and 37.5% [22.5%-52.5%] on onaBoNT-A. Week 12 proportions were 40.9% [20.4%-61.5%] and 33.3% [17.9%-48.7%]. Patient satisfaction at Week 6 was reported as "much better" by 44.1% [27.4%-60.8%] and 29.3% [15.3%-43.2%] of patients on aboBoNT-A and onaBoNT-A, respectively. AboBoNT-A safety was consistent with the regulatory label. Week 6 total costs per responder estimates on the overall study cohort on aboBoNT-A vs onaBoNT-A were £411.60 vs £759.18; Week 12 totalled £567.58 vs. £854.93.

CONCLUSIONS: These data suggest switching a hospital practice from onaBoNT-A to aboBoNT-A could improve clinical outcomes, patient satisfaction, and efficiency.