Abstract Details

Title Conversion to Incobotulinumtoxin A; a Practical Review of Clinical Indications

Topic Movement Disorders

Presentation(s) P07 - (-)

Poster/Presentation
Number 200

Objective

Background BACKGROUND: Both onabotulinumtoxin A (obtxA) and rimabotulinumtoxin B (rbtxB) have been main formulary options at San Antonio military treatment facilities to treat various clinical indications. Recently, ibtxA was added to our formulary, based on cost advantage and ease of storage (refrigeration not required pre-reconstitution). Several patients have been converted from obtxA to ibtxA as a replacement serotype A, the decision for this based on physician preference and patient consent for conversion.

Design/Methods DESIGN/METHODS: Case series. 29 patients were converted from obtxA to ibtxA for the following indications: blepharospasm (N=3), cervical dystonia[CD] (N=4), cervicalgia (N=2), hemifacial spasm (N=6), migraine headache (N=9), spasticity (N=3), and tension headache (N=2). Patients had received from 1-6 cycles (average=3) of ibtxA injections since conversion, administered every 10-12 weeks. Change in effectiveness compared to obtxA was graded by each patient on a 3-point scale: +1 = improved response, 0 = stable response, -1 = reduced/lack of response.

Results RESULTS: Change in effectiveness per clinical indication: blepharospasm=0; CD=+1, cervicalgia=0, HFS=0, migraine=-1, spasticity=0, tension headache=0. The most striking trend noted was a reduced responsiveness to ibtxA in migraine patients; 4/9 patients (44%) noted a reduction in control compared to obtxA and required conversion back.

Conclusions CONCLUSIONS: Use of ibtxA was equivalent, or superior (for CD), to obtxA for movement disorders and conditions related to increased muscle stiffness. Interestingly, migraine headaches were far less responsive to ibtxA than other indications. Future studies with larger cohorts will be required to investigate this further.

Authors/Disclosures
Patrick M. Grogan, MD, FAAN (Neurology Associates) PRESENTER	No disclosure on file
Maria V. Alvarez, MD (Neurology Assciates)	No disclosure on file
Anthony K. Sestokas, PhD (SpecialtyCare)	No disclosure on file
John H. Sladky, MD, FAAN (San Antonio Military Medical Center/MCHE MDU)	Dr. Sladky has nothing to disclose.
Wendy Chao, DO	No disclosure on file

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