Objective: To describe characteristics and treatment response of patients with anterocollis (AC) treated with onabotulinumtoxinA (onabotA).

Background: CD-PROBE included onabotA-treated patients with AC, providing an opportunity to examine this rare cervical dystonia (CD) subtype that is often undertreated despite being disabling.

Method: CD-PROBE was an observational, multicenter, prospective study designed to identify real-world outcomes in patients with CD after onabotA treatment. Included patients 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 AC (n=59) were older (median age 65.5y) and more often disabled (15.3%) than patients with laterocollis (LC; median age 58.1y, 10.9% disabled) or torticollis (TC; median age 58.0y, 11.5% disabled). Patients with AC had a shorter mean time to diagnosis (2.8y) than those with RC (3.5y), LC (5.2y), or TC (5.2y), and a shorter mean time to treatment (0.8y) than patients with LC (1.0y) or TC (1.5y). From PGI-C and CGI-C responses, 48% and 61% of AC patients stated that they were much/very much improved by onabotA post injection 3 (final visit). The mean total TWSTRS score decreased for AC patients from injection 1 (46) to final visit (36); all CDIP-58 domain scores also improved. The proportion of AC patients with physician-assessed severe CD decreased from injection 1 (28.8%) to final visit (21.7%), revealing an overall shift to lower severity levels. Improvements in patient-reported outcomes were greater in response to onabotA than physician-assessed outcomes. Dose of onabotA generally increased per visit, with AC patients having the lowest doses (153.5–195.4 U) compared with RC, LC, and TC subtypes. The safety profile of onabotA in AC patients was consistent with label and comparable with that of other CD subtypes. Dysphagia was reported in 4 patients.

Conclusion: CD PROBE data shows that real-world treatment with onabotA relieves CD symptoms in patients with anterocollis, based on patient and physician ratings.

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