A double-blind, randomised, crossover trial of two botulinum toxin type a in patients with spasticity

Fábio Coelho Guarany, Paulo Dornelles Picon, Nicole Ruas Guarany, Antonio Cardoso dos Santos, Bianca Paula Mentz Chiella, Carolina Rocha Barone, Lúcia Costa Cabral Fendt, Pedro Schestatsky, Fábio Coelho Guarany, Paulo Dornelles Picon, Nicole Ruas Guarany, Antonio Cardoso dos Santos, Bianca Paula Mentz Chiella, Carolina Rocha Barone, Lúcia Costa Cabral Fendt, Pedro Schestatsky

Abstract

Background: Botulinum toxin type A (btxA) is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox® in focal dystonia. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity.

Methodology/principal findings: We performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. The main outcomes were changes in the patients' Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups.

Conclusion: Our results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.

Trial registration: ClinicalTrials.gov NCT00819065.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. CONSORT 2012 Flow diagram of…
Figure 1. CONSORT 2012 Flow diagram of patients.

References

    1. Pandyan AD, Johnson GR, Price CI, Curless RH, Barnes MP, et al. (1999) A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity. Clin Rehabil 13: 373–383.
    1. Cardoso E, Rodrigues B, Lucena R, Oliveira IR, Pedreira G, et al. (2005) Botulinum toxin type A for the treatment of the upper limb spasticity after stroke: a meta-analysis. Arq Neuropsiquiatr 63: 30–33.
    1. Simpson DM, Gracies JM, Graham HK, Miyasaki JM, Naumann M, et al. (2008) Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 70: 1691–1698.
    1. Childers MK, Brashear A, Jozefczyk P, Reding M, Alexander D, et al. (2004) Dose-dependent response to intramuscular botulinum toxin type A for upper-limb spasticity in patients after a stroke. Arch Phys Med Rehabil 85: 1063–1069.
    1. Mayer NH, Esquenazi A, Childers MK (1997) Common patterns of clinical motor dysfunction. Muscle Nerve Suppl 6: S21–35.
    1. Brashear A (2008) Clinical comparisons of botulinum neurotoxin formulations. Neurologist 14: 289–298.
    1. Quagliato EM, Carelli EF, Viana MA (2010) A prospective, randomized, double-blind study comparing the efficacy and safety of type a botulinum toxins botox and prosigne in the treatment of cervical dystonia. Clin Neuropharmacol 33: 22–26.
    1. Rieder CR, Schestatsky P, Socal MP, Monte TL, Fricke D, et al. (2007) A double-blind, randomized, crossover study of prosigne versus botox in patients with blepharospasm and hemifacial spasm. Clin Neuropharmacol 30: 39–42.
    1. Russman BS, Tilton A, Gormley ME, Jr. (1997) Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment. Muscle Nerve Suppl 6: S181–193.
    1. Richardson D, Sheean G, Werring D, Desai M, Edwards S, et al. (2000) Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. J Neurol Neurosurg Psychiatry 69: 499–506.
    1. Piaggio G, Elbourne DR, Altman DG, Pocock SJ, Evans SJ (2006) Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement. JAMA 295: 1152–1160.
    1. Bakheit AM, Fedorova NV, Skoromets AA, Timerbaeva SL, Bhakta BB, et al. (2004) The beneficial antispasticity effect of botulinum toxin type A is maintained after repeated treatment cycles. J Neurol Neurosurg Psychiatry 75: 1558–1561.
    1. Guarany FC, Santos AC, Krug BC, Amaral KM (2010) Espasticidade. In: Picon P, Gadelha MIP, Beltrame A, editors. Protocolos Clínicos e Diretrizes Terapêuticas, Volume 1. Brasília: Ministério da Saúde. 291–306.
    1. Picon PD, Guarany FC, Socal MP, Leal MP, Laporte EA, et al... (2007) Implementation of Brazilian guidelines for botulinum toxin: a three-year follow-up of a cost-reduction strategy in the public health system of Rio Grande do Sul, Brazil. Oral presentation of the 4th Health Technology Assessment International Annual Meeting. Barcelona, Spain.

Source: PubMed

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