Objective: To investigate whether Dysport increases waning time compared to other botulinum toxin type A (BoNT-A) formulations for cervical dystonia (CD) therapy.

Background: BoNT-A injections are the first line of therapy for treating CD, however many patients experience short lasting and suboptimal treatment relief with Botox/Xeomin BoNT-A formulations. A “yo-yo” pattern in symptom relief impacts quality of life as effects begin 1-2 weeks post-injection and peak effect occurs between 4-6 weeks with early waning times.^1,2 Past studies have suggested that Dysport may have a longer waning time and a better treatment response than Botox/Xeomin for alleviating CD symptoms.^3,4

Method: 27 CD patients receiving the same (≥3 cycles) Botox/Xeomin injections with a ≤60-day waning time were recruited from the London Movement Disorders Centre. Patients were converted to Dysport using a 1:2.5 dose ratio for the 1^st injection. Optimizations occurred for the 2^nd and 3^rd Dysport injections. Patients were converted back to their original BoNT-A formulation for the 4^th injection using the same injection pattern as the 3^rd injection. Treatments were administered every 12 weeks. Peak effect (4-weeks) was collected following the original BoNT-A (pattern used in clinic), 3^rd and 4^th cycles. The Toronto Western Spasmodic Torticollis rating scale (TWSTRS) and objective kinematic measures of CD symptoms (static head posturing and dynamic dystonic movements) were collected at all study visits. Significant changes in total dose, waning time, TWSTRS and kinematic outcomes were compared using repeated-measures ANOVA tests.

Results: Dysport significantly increased waning time by 45% (21 days) compared to Botox/Xeomin formulations. CD severity, disability, and pain scores were significantly lower by a mean 29% after Dysport (12 weeks post) compared to Botox/Xeomin injections. Disability was significantly reduced by 47% at peak effect of Dysport compared to the original BoNT-A (4^th injection). Dysport significantly reduced dystonic posturing and dynamic movements following the 1^st injection. Total dose was significantly higher by 20% for the 2^nd and 3^rd injections compared to the original pattern/1^st injection.

Conclusion: Conversion to Dysport improved treatment duration and response compared to other BoNT-A formulations. Dysport may be tried in patients with short and suboptimal treatment responses.

References: 1. Comella C, Ferreira JJ, Pain E, Azoulai M, Om S. Patient perspectives on the therapeutic profile of botulinum neurotoxin type A in cervical dystonia. J Neurol. 2021 Mar;268(3):903-912. doi: 10.1007/s00415-020-10217-7. Epub 2020 Sep 16. Erratum in: J Neurol. 2020 Oct 26;: PMID: 32939574; PMCID: PMC7914227.
2. Sethi KD, Rodriguez R, Olayinka B. Satisfaction with botulinum toxin treatment: a cross-sectional survey of patients with cervical dystonia. J Med Econ. 2012;15(3):419-23. doi: 10.3111/13696998.2011.653726. Epub 2012 Jan 18. Erratum in: J Med Econ. 2013;16(2):327. PMID: 22208596.
3. Esquenazi A, Delgado MR, Hauser RA, Picaut P, Foster K, Lysandropoulos A, Gracies JM. Duration of Symptom Relief Between Injections for AbobotulinumtoxinA (Dysport®) in Spastic Paresis and Cervical Dystonia: Comparison of Evidence From Clinical Studies. Front Neurol. 2020 Sep 25;11:576117. doi: 10.3389/fneur.2020.576117. PMID: 33101184; PMCID: PMC7546809.
4. Ranoux D, Gury C, Fondarai J, Mas JL, Zuber M. Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):459-62. doi: 10.1136/jnnp.72.4.459. PMID: 11909903; PMCID: PMC1737843.

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