Objective: Describe abobotulinumtoxinA (aboBoNT-A) dosing parameters for the most currently targeted muscles in the routine management of lower limb spasticity.

Background: The efficacy and safety of aboBoNT-A for lower limb spasticity has been well-established in randomized controlled studies. Observational studies, conducted in routine treatment settings, add to the evidence base of effectiveness and are useful to inform about the current management of lower limb spasticity allowing for different clinical practices.

Method: Prospective, observational study (NCT04050527). Ambulatory adult patients (≥18 years) with unilateral lower limb spasticity (able to take ≥5 steps with or without assistance) were treated in accordance with local prescribing guidelines (maximum dose 1500U). Participants could be naive to botulinum toxin or previously treated. Injection parameters, including dose, localization, technique, injection intervals and rehabilitation interventions delivered were documented.

Results: The effectiveness population included 384 adults with lower limb spasticity (mean ±SD age 53.9 ±13.8 years; 66.4% male; 75% previously treated with BoNT-A). The median total injected dose of aboBoNT-A was 600U [range 100-1475 U], which was injected into a median of 4 muscles [1-8]. Across cycles 1 to 5, the most frequently injected muscles were the gastrocnemius medial (injected in up to 84% of participants per cycle) and lateral (up to 74%) heads, soleus muscle (up to 67%), tibialis posterior muscle (up to 50%), flexor digitorum longus muscle (up to 41%) and flexor hallucis longus muscle (up to 22%). Less than 15% of participants were injected in other lower-limb muscles. Median doses for the most frequently injected muscles at Cycle 1 are shown in figure 1 [figure1].

Conclusion: In this routine practice study, 6 muscles were identified as being most frequently injected for lower limb spasticity. Injection practice was consistent with treatment of foot equinus and/or varus as the most common pattern of spasticity for the lower limb. On average, total aboBoNT-A doses for the lower limb muscles were lower than approved but were effective in addressing goal attainment.

[figure1]

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MDS Abstracts - https://www.mdsabstracts.org/abstract/muscle-selection-and-dosing-in-patients-undergoing-treatment-with-abobotulinumtoxina-for-lower-limb-spasticity-in-real-world-practice/