Article

AbobotulinumtoxinA has beneficial effects on spasticity and active
movements in hemiparetic adults with upper limb spasticity (ULS). However,
evidence-based information on optimal dosing for clinical use is limited.
OBJECTIVE: To describe joint-specific dose effects of abobotulinumtoxinA in
adults with ULS. DESIGN: Secondary analysis of a phase 3 study (NCT01313299).
SETTING: Multicenter, international, double-blind, placebo-controlled clinical
trial. PARTICIPANTS: A total of 243 adults with ULS >6 months after stroke or
traumatic brain injury, aged 52.8 (13.5) years and 64.3% male, randomized 1:1:1
to receive a single-injection cycle of placebo or abobotulinumtoxinA 500 U or
1000 U (total dose). METHODS: The overall effects of injected doses were assessed
in the primary analysis, which showed improvement of angles of catch in finger,
wrist, and elbow flexors and of active range of motion against these muscle
groups. This secondary analysis was performed at each of the possible doses
received by finger, wrist, and elbow flexors to establish possible dose effects.
MAIN OUTCOME MEASURES: Angle of arrest (XV1) and angle of catch (XV3) were
assessed with the Tardieu Scale, and active range of motion (XA). RESULTS: At
each muscle group level (finger, wrist, and elbow flexors) improvements in all
outcome measures assessed (XV1, XV3, XA) were observed. In each muscle group,
increases in abobotulinumtoxinA dose were associated with greater improvements in
XV3 and XA, suggesting a dose-dependent effect. CONCLUSIONS: Previous clinical
trials have established the clinical efficacy of abobotulinumtoxinA by total dose
only. The wide range of abobotulinumtoxinA doses per muscle groups used in this
study allowed observation of dose-dependent improvements in spasticity and active
movement. This information provides a basis for future abobotulinumtoxinA dosing
recommendations for health care professionals based on treatment objectives and
quantitative assessment of spasticity and active range of motion at individual
joints. LEVEL OF EVIDENCE: I.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS