Objective: To study whether incobotulinumtoxinA (INCO), a new, low-antigenicity botulinum toxin (BT) drug, increases BT antibody (BTAB) titers in patients with antibody-induced therapy failure (ABTF) whose BTAB titers had dropped.

Background: Antibody-induced therapy failure is a well known problem of BT therapy.

Methods: A total of 8 patients with cervical dystonia and ABTF (6 women, 2 men; ages 41.4 ± 12.1 years; disease duration, 6.6 ± 4.7 years) were studied. One patient had received onabotulinumtoxinA (ONA) only; 3 had received abobotulinumtoxinA (ABO) only; 3 had received ABO and then ONA; and 1 had received rimabotulinumtoxinB (RIMA) and then ONA before ABTF with maximal BTAB titers occurred. All BTAB titers had dropped to insignificant levels before BT therapy was restarted with INCO. 

Results: Treatment parameters before and after restart were as follows: single dose, 191.5 ± 55.2 mouse units (MU) vs 259.0 ± 100.6 MU; interinjection interval (days), 116.7 ± 20.9 vs 104.5 ± 14.7 MU; cumulative dose, 1903.8 ± 1168.6 MU vs 5130.4 ± 3602.5 MU; and treatment time (days), 954.1 ± 512.9 vs 1895.4 ± 1211.4. Repeated BTAB measurements and clinical  examination did not reveal any signs of ABTF after restart.

Conclusions: Even when INCO is given at higher single doses, shorter injection intervals, and higher cumulative doses, it does not produce ABTF. INCO offers a new, long-term opportunity for ABTF patients when BTAB titers have dropped. This observation supports the prediction that INCO has a lower antigenicity than do conventional BT drugs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antibody-induced-failure-of-botulinum-toxin-therapy-restart-with-incobotulinumtoxina-offers-a-new-opportunity/