To describe annual injection frequency and toxin-switching rates for botulinum toxin A in the treatment of spasticity.

Botulinum toxin is indicated for treatment of spasticity, but limited information is available on real-world botulinum toxin treatment patterns in the United States.

This study assessed medical claims data, pharmacy claims data, and enrollment information from the Truven MarketScan database (TMD) and the Optum Clinformatics™ Data Mart (CDM) among adults with continuous health plan enrollment and ≥1 medical claim for spasticity between 2016–2019. Index date was the date of index toxin (first toxin observed on a medical claim during the study period) with a spasticity diagnosis. Included patients were analyzed 3 ways. The “annual” and “pooled” cohorts focused on each year (2016–2019) and across years, respectively. The “pooled” cohort allowed each patient to contribute multiple years of full enrollment with a spasticity-related toxin. The “treatment initiators” cohort comprised patients who did not have any spasticity-related toxin claims in the 6-month baseline period.

Across the TMD and CDM datasets, mean annual numbers of administrations across each year for all toxins ranged from 1.62−2.26 in 2016, 1.98−2.28 in 2017, 2.06−2.52 in 2018, and 2.11−2.29 in 2019. Mean annual numbers of administrations for all toxins in the pooled cohort ranged from 1.97−2.33 and 2.08−2.81 in treatment initiators cohort. The percentage of patients switching from index toxin for each year (2016−2019) ranged from 0.8%−1.9% for onabotulinumtoxinA, 2.4%−9.0% for abobotulinumtoxinA, and 4.7%−16.1% for incobotulinumtoxinA. Switch rates for onabotulinumtoxinA compared to other botulinum toxins were 1.1%−3.2% vs 3.0%−16.4% in the pooled cohort and 1.3%−1.9% vs 2.2%−12.5% in the treatment initiators cohort.

In the real world, injection frequency is similar across toxins in the treatment of spasticity. Patients with spasticity switch less from onabotulinumtoxinA compared to other botulinum toxin type A therapies.