OnabotulinumtoxinA treatment for spasticity is variable and dependent on numerous factors.

Patients (N=730) were on average 53.6 years of age (18.5-93.2 years), 52% female, and predominantly Caucasian (77%). Stroke was the most frequently reported etiology (56%). The most commonly treated lower limb spasticity presentation was equinovarus foot (59%). Across all equinovarus foot treatment sessions (N=1609), percentage injected and dose (mode) injected into each muscle were as follows: gastrocnemius (79%, 100U), soleus (70%, 100U), tibialis posterior (48%, 50U), flexor digitorum longus (21%, 50U), flexor hallucis longus (8%, 50U) and other muscle (13%, 50U). EMG was frequently used to localize the muscles to treat equinovarus foot (>40%). Across all treatment sessions, 95% of clinicians and 85% of patients reported being satisfied/extremely satisfied that treatment helped manage spasticity, and 98% of clinicians and 92% of patients would definitely/probably continue treatment with onabotulinumtoxinA. 261 patients (36%) reported 831 adverse events (AEs); 23 AEs in 20 patients (3%) were considered treatment-related. 94 patients (13%) reported 195 serious AEs; 3 serious AEs in 2 patients (0.3%) were considered treatment-related. No new safety signals were identified. 

ASPIRE provides valuable, real-world data on dosing, injection guidance, and muscle targeting over 2 years, that may help guide clinical strategies. ASPIRE captured the individualized nature of onabotulinumtoxinA utilization for spasticity, while demonstrating consistently high satisfaction. These results add to the body of evidence on the safety and effectiveness of onabotulinumtoxinA for spasticity.