Abstract Details

Title The Impact of OnabotulinumtoxinA on Oral Pain Medication Use and Low-value Care in Patients With Cervical Dystonia

Topic Pain

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-009

Objective We evaluated the impact of onabotulinumtoxinA treatment on opioid, skeletal muscle relaxant (SMR), and benzodiazepine (BZD) use among patients diagnosed with cervical dystonia (CD) with prior use of these medications.

Background OnabotulinumtoxinA is the only botulinum toxin indicated to treat abnormal head position and neck pain in cervical dystonia.

Design/Methods This retrospective cohort analysis evaluated claims from January 2017-December 2023 using medical and pharmacy claims data. Three cohorts were identified based on medication use data from eligible CD-diagnosed patients during the 12 months prior to onabotulinumtoxinA treatment initiation (index date): opioid, SMR, and BZD cohorts. The follow-up period continued for 12 months from the index date. Changes in number of opioid, SMR, and BZD prescription fills and opioid daily dose per patient (morphine milligram equivalent [MME]/day) were assessed in respective cohorts.

Results 564 eligible patients were identified, with non-mutually exclusive opioid (n=306), SMR (n=371), and BZD (n=271) cohorts. Patient characteristics were similar across cohorts, with the overall average patient being white (64.9%), female (71.6%), and 58.1 years old. Among patients with >1 opioid fill at baseline (opioid cohort), 30.4% had no opioid fills in the 12-month period following onabotulinumtoxinA initiation. The opioid cohort had significantly reduced mean opioid prescription fills per patient (17.0%; p<0.001) in the follow-up period compared with baseline. A 30.0% decrease was observed in mean MME/day after onabotulinumtoxinA initiation (p<0.001). Similarly decreased SMR and BZD utilization trends were observed. Following onabotulinumtoxinA initiation, 34.2% of the SMR cohort and 32.5% of the BZD cohort had no SMR or BZD prescription fills, respectively.

Conclusions Patients with CD and prior opioid, SMR, and/or BZD use had significantly reduced opioid, SMR, and BZD utilization, respectively, for 12 months after initiating onabotulinumtoxinA compared with the preceding 12-month period. OnabotulinumtoxinA is indicated to reduce CD-related pain and may reduce opioid use in patients.

Authors/Disclosures
Bahman Jabbari, MD, FAAN PRESENTER	Dr. Jabbari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jabbari has received publishing royalties from a publication relating to health care.
Annaliza Dominguez, PharmD, MS	Dr. Dominguez has received personal compensation for serving as an employee of AbbVie. Dr. Dominguez has stock in AbbVie.
Ning Cheng, PhD	Dr. Cheng has received personal compensation for serving as an employee of Abbvie.
Shivaji Manthena, Director RWE Analytics	Mr. Manthena has received personal compensation for serving as an employee of Abbvie. Mr. Manthena has stock in Abbvie.
Darshini Shah, Other (AbbVie Inc)	Ms. Shah has received personal compensation for serving as an employee of AbbVie. Ms. Shah has stock in AbbVie Inc. An immediate family member of Ms. Shah has received research support from National Institutes of Health.
Christopher P. Rhyne, MD (Diamond Headache Clinic)	Dr. Rhyne has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Rhyne has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie/Allergan. Dr. Rhyne has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Abbvie/Allergan. Dr. Rhyne has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lundbeck.

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