Real-World Adherence to OnabotulinumtoxinA Treatment for Spasticity: Insights From the ASPIRE Study

• Published in: Archives of physical medicine and rehabilitation Vol. 102; no. 11; pp. 2172 - 2184.e6
• Main Authors: Esquenazi, Alberto, Francisco, Gerard E., Feng, Wuwei, Baricich, Alessio, Gallien, Philippe, Fanning, Kristina, Zuzek, Aleksej, Bandari, Daniel S., Wittenberg, George F.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2021
• Subjects: Botulinum toxins; Rehabilitation; Stroke; Treatment adherence and compliance; Stroke; OR; Botulinum toxins; CI; MS; DAS; Rehabilitation; Treatment adherence and compliance; ASPIRE
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2021.06.008

•Analyses reveal key clinical variables associated with onabotulinumtoxinA adherence.•Key adherent variables: used orthotics and treated in Europe.•Key nonadherent variables: retreatment ≥15 weeks, used assistive devices, Disability Assessment Scale pain.•Most patients adhered to onabotulinumtoxinA, >5 sessions in 2 years for adherents.•Real-world evidence from the Adult Spasticity International Registry study can enhance spasticity patient care. To identify baseline characteristics and treatment-related variables that affect adherence to onabotulinumtoxinA treatment from the Adult Spasticity International Registry (ASPIRE) study. Prospective, observational registry (NCT01930786). International clinical sites. Adults with spasticity (N=730). OnabotulinumtoxinA at clinician's discretion. Clinically meaningful thresholds used for treatment adherent (≥3 treatment sessions during 2-year study) and nonadherent (≤2 sessions). Data analyzed using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Treatment-related variables assessed at sessions 1 and 2 only. Of the total population, 523 patients (71.6%) were treatment adherent with 5.3±1.6 sessions and 207 (28.4%) were nonadherent with 1.5±0.5 sessions. In the final model (n=626/730), 522 patients (83.4%) were treatment adherent and 104 (16.6%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=1.84; CI, 1.06-3.21; P=.030) and use of orthotics (OR=1.88; CI, 1.15-3.08; P=.012). Baseline characteristics associated with nonadherence: history of diplopia (OR=0.28; CI, 0.09-0.89; P=.031) and use of assistive devices (OR=0.51; CI, 0.29-0.90; P=.021). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.43; CI, 0.26-0.72; P=.001) and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR=0.18; CI, 0.05-0.69; P=.012). Of the population with stroke (n=411), 288 patients (70.1%) were treatment adherent with 5.3±1.6 sessions and 123 (29.9%) were nonadherent with 1.5±0.5 session. In the final stroke model (n=346/411), 288 patients (83.2%) were treatment adherent and 58 (16.8%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=2.99; CI, 1.39-6.44; P=.005) and use of orthotics (OR=3.18; CI, 1.57-6.45; P=.001). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.42; CI, 0.21-0.83; P=.013) and moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR=0.40; CI, 0.19-0.83; P=.015). These ASPIRE analyses demonstrate real-world patient and clinical variables that affect adherence to onabotulinumtoxinA and provide insights to help optimize management strategies to improve patient care.