Objective: Investigate which factors influence patient satisfaction with botulinum neurotoxin type A (BoNT-A) treatment for cervical dystonia (CD) in routine practice.

Background: We have previously reported that the factors most strongly associated with BoNT-A response were age (<40 years; OR 3.9, p<0.05) & absence of baseline head tremor (OR 1.5; not significant) [Misra et al 2012]. Here we focus on patient satisfaction.

Methods: INTEREST IN CD2 is an ongoing observational study of CD patients treated with BoNT-A. We performed multivariate stepwise logistic regression analyses to determine potential predictors for: (1) ‘Today satisfaction’, where subjects rate their satisfaction at the end of a treatment cycle & before the next injection and (2) ‘Highest satisfaction’, where subjects recall their highest level of satisfaction over the previous treatment cycle. In each analysis: Step 1 was univariate logistic regression analyses, which each included one of the baseline factors (e.g. demographics, CD patterns, Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] and Tsui scores, injection practice, concomitant medications); Step 2 assessed the factors retained as potentially predictive for satisfaction in Step 1 (i.e. with p<0.2), and Step 3 was a multivariate stepwise logistic regression analysis of those factors retained after Step 2.

Results: Analyses included data from 863 subjects. Of the 35 potential factors (assessed at start of treatment cycle before the 1st study injection), baseline TWSTRS-total score was the only factor significantly associated with ‘Today’ satisfaction from the multivariate analysis (OR [95%CI] = 0.978 [0.968-0.988]; p<0.0001). For analysis of ‘Highest’ satisfaction, similarly lower baseline TWSTRS-total score (OR [95%CI] = 0.974 [0.959-0.988], p=0.0004) as well as absence of multifocal dystonia (OR [95%CI] = 0.275 [0.091-0.828]; p=0.0217) were associated with higher satisfaction. Low (<Q1 doses) BoNT-A dosing (compared to medium [Q1 to Q3] dosing) was associated with lower satisfaction (OR [95%CI] = 0.518 [0.322-0.835]; p=0.0021).

Conclusions: This analysis affirms that underdosing BoNT-A is associated with reduced patient satisfaction.  More importantly, subjects with less severe CD (as indicated by lower TWSTRS-total scores and absence of multifocal dystonia) are more likely to be satisfied with BoNT-A treatment.          

References: Misra et al. BMJ Open. 2012; 2(3). pii: e000881.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/which-factors-predict-patient-satisfaction-with-botulinum-toxin-treatment-for-cervical-dystonia/