Objective: To characterize real-world long-term utilization of onabotulinumtoxinA (onabotA) for cervical dystonia (CD) treatment by describing demographic characteristics, clinical features, and treatment patterns of patients who received ≥4 consecutive years of treatment.

Background: OnabotA was approved to treat CD in adults in 2000; however, real-world long-term utilization data are limited beyond 3-8 treatment cycles.

Method: This retrospective observational study assessed longitudinal patient-level claims data from Optum’s de-identified Clinformatics^® Data Mart Database (1/1/2010-9/30/2024). Analysis was conducted on adults (≥18 years) with CD (≥1 inpatient or 2 outpatient diagnoses ≥90 days apart) and ≥48 months of continuous health plan enrollment (gap ≤90 days) on or after the first diagnosis date during the study period who received ≥1 onabotA injection for CD each year from the date of first onabotA treatment for ≥4 continuous years.

Results: Of 2,272 patients who had injections within or after 12 months from the first onabotA injection, 1,094 met the inclusion criteria. Mean (SD) age was 64 (12) years, 77.5% were female, 77.3% were White, and 73.5% had Medicare. Common comorbidities were neck pain (59.7%), other dystonias (59.3%), anxiety (58.0%), and depression (46.4%). Throughout the study, patients had a mean (SD) of 18.1 (7.7) onabotA treatments with 3.8 (2.2) months between 2 consecutive injections. Mean (SD) dose per cycle was 158.9 (102.3) units (<100: 32.9%; 100-<200: 38.1%; 200-<400: 22.7%; 400-<600: 5.3%; ≥600: 1.0%) and increased from 148.3 (cycle 1) to 172.3 (cycle 18) units. Lower doses (133-145 units) were observed among those not remaining on treatment long term. Localization techniques for injection were electromyography (EMG; 69.2%), ultrasound (5.1%), and E-stim (0.2%). Opioids were used by 24% of patients during the 6 months before onabotA start; opioid use decreased from 23.9% (cycle 1) to 17.4% (cycle 18). OnabotA providers practiced mainly in neurology (58.0%), general practice (16.1%), rehabilitation (12.0%), or other (21.7%). Some patients also received onabotA for spasticity (19.7%), blepharospasm (18.7%), and chronic migraine (4.6%).

Conclusion: Patients on long-term continuous treatment with onabotA for CD received treatment every 3.8 months, with localization mainly by EMG and administration primarily by neurologists. Over time, onabotA doses increased and opioid use appeared to decline.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-utilization-of-onabotulinumtoxina-for-the-treatment-of-cervical-dystonia/