Objective: To compare real-world clinical utilization of onabotulinumtoxinA (onabotA) and abobotulinumtoxinA (abobotA) in the treatment of adult upper limb spasticity (ULS).

Background: In the US, 3 botulinum toxin type A (BoNT/A) products are approved by the US Food and Drug Administration (FDA) to treat ULS. Each BoNT/A product is manufactured and tested via proprietary processes, resulting in unique clinical profiles. To this end, FDA-mandated boxed warnings state that potency units of one product are not interchangeable and cannot be converted into units of another BoNT/A product. In this retrospective study, we compared real-world clinical utilization of onabotA and abobotA in the treatment of adult ULS.

Method: De-identified medical records were obtained via survey of 101 unique healthcare professionals on patients diagnosed with ULS per International Classification of Diseases, 10th revision, (ICD-10) and treated via botulinum toxin using current procedural terminology (CPT) in the US. 215 patient charts were reviewed: 107 treated with onabotA and 108 with abobotA. Patients received at least 3 treatments of onabotA or abobotA in 1 spastic upper limb prior to March 2020. Number and type of muscles injected were compared between BoNT/A products.

Results: Overall, 75% of patients were classified as having moderate-to-severe ULS  by the injector. On average, patients were diagnosed with ULS for >3 years: onabotA 44.2 months (10-200) or abobotA 40.0 months (11-212). A significantly greater average number of muscles were injected with onabotA (4.3; range, 1 to 16), compared with abobotA (3.1; range, 1 to 8), P=0.0001. Significantly more patients received onabotA injections in forearm muscles (87/107, 81.3%) compared with abobotA (70/108, 64.8%), P=0.0064. Similarly, a significant difference was observed in the utilization of onabotA in hand muscles (23/107, 21.5%) compared with abobotA (4/108, 3.7%), P=0.0001.

Conclusion: This study provides real-world evidence that onabotA is used across a greater number of muscles and joints of the spastic upper limb compared with abobotA, suggesting differences in product characteristics. Additionally, these results are consistent with published evidence across other indications, further supporting that each BoNT/A product is unique and not interchangeable as indicated by the FDA.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-clinical-utilization-differences-of-onabotulinumtoxina-and-abobotulinumtoxina-in-upper-limb-spasticity/