Objective: To describe incobotulinumtoxinA doses and muscles injected in a real-world setting for patients with cervical dystonia (CD)
Background: IncobotulinumtoxinA is approved to treat CD in adults. Patterns of muscle selection, dosing, and patient characteristics of those treated with incobotulinumtoxinA in real-world settings are not well-described.
Method: This was a retrospective, observational study utilizing electronic health records (EHR). Adults with a CD diagnosis and treatment with incobotulinumtoxinA from 1/1/2015-12/31/2022 were included in this analysis. The index visit was the first incobotulinumtoxinA encounter in this time frame. Prevalent and new users were included. Units and muscles injected were manually abstracted from clinical notes from encounters for incobotulinumtoxinA treatment. All analyses were descriptive.
Results: There were 146 patients identified. Average age was 58 years old, 69% were female, and 27% of patients had prior incobotulinumtoxinA use. There were 608 incobotulinumtoxinA encounters analyzed with most patients (60%) contributing 3 or fewer visits. The most commonly injected muscles were splenius, semispinalis, trapezius, and sternocleidomastoid, with individual muscle dosing largely aligning to those studied in pivotal clinical studies. There were 183 unique muscle combinations identified, suggesting highly customized treatment approaches for different CD-related postures. At the index visit, the average dose for CD was 134 units (SD 109) with a median dose of 92.5 (IQR 50-188.75). The median number of units wasted was low, with a mean of 20 units (median 17) at the index visit.
Conclusion: The doses of incobotulinumtoxinA and muscles injected for CD were found to be highly individualized in this retrospective EHR-based analysis. The assessment of clinical notes was key as information on dosing and muscles cannot typically be obtained from administrative claims or structured EHR data. Very little wastage of incobotulinumtoxinA units was recorded in clinical notes.
To cite this abstract in AMA style:
J. Holmes, A. Kong, G. Askin, D. Nomah, D. Joseph, K. Biney, M. Hast. Characteristics of IncobotulinumtoxinA Treatment for Cervical Dystonia in a Real-World Setting: Dosing and Muscles Injected [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/characteristics-of-incobotulinumtoxina-treatment-for-cervical-dystonia-in-a-real-world-setting-dosing-and-muscles-injected/. Accessed November 20, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/characteristics-of-incobotulinumtoxina-treatment-for-cervical-dystonia-in-a-real-world-setting-dosing-and-muscles-injected/