OBJECTIVES: Understanding the use of botulinumtoxin (BoNT) in clinical practice is essential for improving clinical care. Real-world evidence for long-term persistence with BoNT therapy is limited. We conducted a retrospective longitudinal study to describe treatment dynamics and persistence with BoNT over 2 years.

METHODS: Medical claims data from the IBM MarketScan database were assessed among patients with a first medical claim for BoNT (not product specific) between October 2016 and October 2019. The index date was the day of the first BoNT administration, and a 1-year washout period before this date was used to identify incident BoNT use. On-label indications (neurological disorders) were defined as those approved for abobotulinumtoxinA. Six cohorts were analyzed: 1, all patients; 2, all patients, excluding those with off-label indications at the index date; 3, all patients with on-label diagnosis during the study period; and 4, 5, and 6, all patients with diagnosis of stroke, migraine, and bladder dysfunction, respectively, before the index date. The number of treatments in the 2-year follow-up period and persistency (120-day look forward from treatment date; 80th percentile value of days to next treatment) were evaluated.

RESULTS: Across all cohorts (cohort: 1 [n=19,711]; 2 [n=5,741]; 3 [n=3,238]; 4 [n=611]; 5 [n=7,778]; and 6 [n=1,791]), 18.8–46.9% of patients received only one BoNT injection. Proportions of patients receiving three to eight injections remained consistent, with 0.3–15.7% receiving eight injections. Across cohorts, mean number of treatments was 2.1–4.7, and time between treatments (80th percentile) was 105–319 days.

CONCLUSIONS: There was a large drop-off in the proportion of patients receiving BoNT treatment after the first injection, with few patients receiving eight injections over 2 years in accordance with the standard treatment regimen. These data are limited in providing the underlying reasons for the drop-off; further research is warranted.