Session Information
Session Title: Live Poster Session: General Rehabilitation
Disclosures: Alberto Esquenazi, MD: Allergan (Products/Services: Yes) (Consultant/Advisory Board, Research Grant or Support, Research Grant includes principal investigator, collaborator or consultant and pending grants as well as grants already received)
Objective: To help understand clinical strategies to manage spasticity, we aimed to identify baseline clinical characteristics and treatment-related factors that impact adherence to onabotulinumtoxinA treatment in post-stroke and multiple sclerosis (MS) patients from the Adult Spasticity International Registry (ASPIRE) study.
Design: Prospective, observational registry (NCT01930786). Setting : International clinical sites. Participants : Adults with focal spasticity.
Interventions: OnabotulinumtoxinA at clinician’s discretion.
Main Outcome Measures: Clinically meaningful thresholds for treatment adherence/non-adherence were used. Adherent: patients receiving ≥3 treatment sessions with onabotulinumtoxinA during 2-year study; non-adherent: patients receiving ≤2 treatment sessions. Data were analyzed using univariate and multivariate logistic regression models and are presented as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was accepted at P < 0.05; non-significant effects of clinical interest at P < 0.10. Treatment-related factors include data from sessions 1 and 2 only.
Results: In the final stroke model (N=346/411), 288 patients (83.2%) were categorized as treatment adherent, with 5.3(±1.6[mean±SD]) sessions, and 58 (16.8%) as non-adherent, with 2.0(±0.0) sessions. Baseline characteristics associated with adherence: European patient (OR:2.91;CI:1.35-6.27;P=0.006), use of orthotics (OR:3.12;CI:1.54-6.34;P=0.002), and prior surgeries/procedures (OR:3.22;CI:0.92-11.27;P=0.068); treatment-related: treatment for thumb-in-palm (OR:2.09;CI:0.93-4.71;P=0.076). Baseline risk factors for non-adherence: higher age at enrollment (OR:0.98;CI:0.95-1.00;P=0.096) and use of assistive devices (OR:0.45;CI:0.20-1.01;P=0.053); treatment-related: treatment interval ≥15 weeks (session 1 to 2; OR:0.42;CI:0.21-0.84;P=0.014), moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR:0.39;CI:0.19-0.82;P=0.013), and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR:0.18;CI:0.02-1.38;P=0.099). In the final MS model (n=105/119), 92 patients (87.6%) were categorized as treatment adherent, with 5.4(±1.6) sessions, and 13 (12.4%) non-adherent, with 2.0(±0.0). Treatment for stiff extended knee (OR:9.68;CI:1.68-55.80;P=0.011) was associated with adherence, while treatment for equinovarus foot (OR:0.07;CI:0.01-0.57;P=0.012) and treatment interval ≥15 weeks (session 1 to 2; OR:0.11;CI:0.02-0.76;P=0.025) were treatment-related risk factors for non-adherence. Conclusions: These preliminary analyses provide real-world insight into factors that impact adherence to onabotulinumtoxinA treatment for spasticity, which can help optimize management strategies to improve post-stroke and MS patient care.
Level of Evidence: Level II
To cite this abstract in AMA style:
Esquenazi A, Feng W, Wittenberg GF, Gallien P, Baricich A, Fanning K, Zuzek A, Francisco GE, Bandari DS. Adherence to Onabotulinumtoxina Treatment in Post-Stroke and Multiple Sclerosis Patients with Spasticity from the ASPIRE Study [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/adherence-to-onabotulinumtoxina-treatment-in-post-stroke-and-multiple-sclerosis-patients-with-spasticity-from-the-aspire-study/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/adherence-to-onabotulinumtoxina-treatment-in-post-stroke-and-multiple-sclerosis-patients-with-spasticity-from-the-aspire-study/