Objective: To describe characteristics and treatment response to onabotulinumtoxinA (onabotA) of patients with retrocollis (RC).

Background: The CD-PROBE trial of onabotA included patients with RC, affording an opportunity to investigate this rare CD subtype that has been excluded from recent clinical trials despite disabling symptoms.

Method: CD-PROBE was an observational, multicenter, prospective study designed to identify real-world outcomes in patients with CD after treatment with onabotA. Patients
were included if they had a CD diagnosis and were candidates for onabotA therapy, new to treatment or not treated in a prior clinical trial in ≥16 weeks, and completed 3 onabotA treatments. Treatment benefit was measured using the Patient’s Global Impression of Change (PGI-C), Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), Cervical Dystonia Impact Profile (CDIP-58), Clinician’s Global Impression of Change (CGI-C), and physician assessments of CD severity.

Results: Patients with RC (n=55) had a median age (62.0y) between that of those with anterocollis (AC; 65.5y) and those with laterocollis (LC; 58.1y) or torticollis (TC; 58.0y) CD subtypes. Patients with RC were more likely to be disabled than those with other subtypes (RC [20%] vs AC [15.3%], TC [11.5%], LC [10.9%]), with a shorter mean time to diagnosis (3.5y) than patients with LC or TC (5.2y), and shorter mean time to treatment (0.2y) than patients with AC (0.8y), LC (1.0y), or TC (1.5y). From PGI-C and CGI-C responses, 58.4% and 82.6% of RC patients claimed to be much/very much improved by onabotA post-injection 3 (final visit). The mean total TWSTRS score decreased for RC patients from injection 1 (40) to final visit (32); all CDIP-58 domain scores also improved. The proportion of patients with physician-assessed severe CD decreased from injection 1 (21.8%) to final visit (4.3%), at which time 74% of RC patients reported mild severity. Dose of onabotA generally increased per visit with RC patients having the highest doses (184.0–213.4 U) compared with AC, LC, and TC subtypes. OnabotA safety profile in RC patients was consistent with label and comparable with that of other CD subtypes. Dysphagia was reported in 7 patients.

Conclusion: CD PROBE data indicates that real-world treatment with onabotA relieves CD symptoms in patients with the retrocollis subtype, as evaluated by patient and physician assessments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characteristics-and-treatment-response-to-onabotulinumtoxina-of-patients-from-cd-probe-with-retrocollis-subtype-of-cervical-dystonia/