To describe annual injection frequency and toxin-switching rates for botulinum toxin A in the treatment of cervical dystonia (CD).

Limited information is available on real-world botulinum toxin treatment patterns among patients with CD in the United States.

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 CD were assessed between 2016−2019. Index toxin was defined as the first toxin observed on a medical claim during the study period; index date was date of first toxin with a CD 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 CD-related toxin. The “treatment initiators” cohort included patients who did not have any CD-related toxin claims in the 6-month baseline period.

Across the TMD and CDM datasets, the mean annual numbers of administrations across each year for all toxins ranged from 2.40−2.63 in 2016, 2.43−2.75 in 2017, 2.34−2.77 in 2018, and 2.39−3.02 in 2019. Mean annual numbers of administrations across all toxins in the pooled cohort ranged from 2.44−2.75  and 2.35−2.59 in the treatment initiators cohort. For each year (2016−2019), the percentage of patients switching from index toxin ranged from 0.8%−1.6% for onabotulinumtoxinA, 3.2%−9.7% for abobotulinumtoxinA, and 5.6%−10.6% for incobotulinumtoxinA. Switch rates for onabotulinumtoxinA were lower versus the other toxins in the pooled  (1.2%−2.7% vs 6.8%−13.9%) and treatment initiators (1.1%−1.6% vs 6.5%−9.2%) cohorts.

In the real world, injection frequency is similar across toxins in the treatment of CD with patients switching less from onabotulinumtoxinA compared to other botulinum toxin A therapies.