Satisfaction with botulinum toxin treatment in post-stroke spasticity: results from two cross-sectional surveys (patients and physicians)

Abstract

Objective:

To characterize patient and physician satisfaction with current standard-of-care botulinum toxin treatment regimens for symptom control in patients with post-stroke spasticity using structured interviews with patients and physicians.

Research design and methods:

Two cross-sectional surveys were conducted in Canada, France, Germany, and the US. The patient survey included patients with post-stroke spasticity who had undergone at least two botulinum toxin A injection cycles. Information on patients’ current and prior botulinum toxin treatment cycles and quality of life was collected. The physician survey included physicians treating post-stroke spasticity with botulinum toxins and collected information regarding physician satisfaction with botulinum toxin treatment for post-stroke spasticity.

Results:

Of 79 participating patients with post-stroke spasticity, 61 (77%) received treatment with onabotulinumtoxinA, 15 (19%) with abobotulinumtoxinA, and three (4%) with incobotulinumtoxinA. Overall, 40.5% of patients were very satisfied, 48.1% were somewhat satisfied, and 11.4% were not at all satisfied with botulinum toxin treatment. Patient satisfaction was lowest just before injection and highest at the time of peak effect. The mean injection interval was 13.7 (SD = 3.5) weeks; however, 43.4% of patients expressed a preference for intervals of ≤10 weeks. Most of the 105 participating physicians’ were moderately (57.7%) or very (36.5%) satisfied with botulinum toxin treatment. However, physicians estimated that 16.2% of their patients with post-stroke spasticity could benefit from shorter injection intervals, and that 24.6% of patients could benefit from higher doses than those permitted by current country directives.

Study limitations:

Patients’ responses were based on subjective recollections and physicians’ responses were based on general impressions.

Conclusions:

These surveys indicate that patients’ and physicians’ satisfaction with botulinum toxin therapy for post-stroke spasticity is overall very good. However, patients’ satisfaction over the treatment cycle varied with onset, peak, and trough of treatment effects and patients and physicians expressed a need for treatment individualization.

Keywords::

• Spasticity
• AbobotulinumtoxinA
• IncobotulinumtoxinA
• OnabotulinumtoxinA
• Botox

Transparency

Declaration of funding

This study was conceived and sponsored by Merz Pharmaceuticals, GmbH. All authors contributed to the initial drafting of the manuscript, subsequent review and critique, and all authors approved the final draft before submission.

Declaration of financial/other relationships

Djamel Bensmail has received consulting fees or other remuneration (payment) from Allergan, Almirall, Ipsen, Medtronic, and Merz Pharmaceuticals. Angelika Hanschmann is an employee of Merz Pharmaceuticals. Jörg Wissel has received consulting fees and payments for speakers’ bureau from Allergan, Ipsen, Medtronic, and Merz Pharmaceuticals.

Acknowledgments

The authors would like to thank all patients and physicians who participated in the survey and the interviewers who conducted the sessions. The authors would also like to thank Dr. Cindy Ivanhoe (Baylor College of Medicine) for her helpful comments on an earlier draft of the manuscript. Medical writing assistance was provided by Starr L. Grundy, BSc Pharm of SD Scientific, Inc., and Dr. Simone Boldt of Complete Medical Communications, funded by Merz Pharmaceuticals.

Previous presentations: (1) TOXINS 2012: Basic Science and Clinical Aspects of Botulinum and Other Neurotoxins, December 5–8, 2012, Miami Beach, FL, USA; (2) XXI World Congress of Neurology, September 21–26, 2013, Vienna, Austria; and (3) APM&R 2013 Annual Assembly, October 3–6, 2013, National Harbor, MD, USA.

Notes

*Botox is a registered trademark of Allergan Inc.

†Dysport is a registered trademark of Ipsen Biopharm Ltd.

‡Xeomin is a registered trademark of Merz Pharma GmbH & Co. KGaA.