Significant Long-Lasting Improvement after Switch to Incobotulinum Toxin in Cervical Dystonia Patients with Secondary Treatment Failure

Under continuous long-term treatment with abo- or onabotulinum toxin type A (BoNT/A), ~10 to 15% of patients with cervical dystonia (CD) will develop neutralizing antibodies and reduced responsiveness over an ~10-year treatment period. Among the botulinum neurotoxin type A preparations so far licensed for CD, incobotulinum toxin A (incoBoNT/A; Xeomin®) is the only one without complex proteins. Whether CD patients with treatment failure under abo- or onaBoNT/A may still respond to incoBoNT/A is unknown. In this cross-sectional, retrospective study, 64 CD patients with secondary treatment failure after abo- or onaBoNT/A therapy who were switched to incoBoNT/A were compared to 34 CD patients exclusively treated with incoBoNT/A. The initial clinical severity of CD, best outcome during abo- or onaBoNT/A therapy, severity at the time of switching to incoBoNT/A and severity at recruitment, as well as all corresponding doses, were analyzed. Furthermore, the impact of neutralizing antibodies (NABs) on the long-term outcome of incoBoNT/A therapy was evaluated. Patients significantly improved after the switch to incoBoNT/A (p < 0.001) but did not reach the improvement level obtained before the development of partial secondary treatment failure or that of patients who were exclusively treated with incoBoNT/A. No difference between abo- and onaBoNT/A pretreatments or between the long-term outcomes of NAB-positive and NAB-negative patients was found. The present study demonstrates significant long-term improvement after a switch to incoBoNT/A in patients with preceding secondary treatment failure after abo- or onaBoNT/A therapy and confirms the low antigenicity of incoBoNT/A.

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The Impact of the Course of Disease before Botulinum Toxin Therapy on the Course of Treatment and Long-Term Outcome in Cervical Dystonia

Toxins ◽

10.3390/toxins13070493 ◽

2021 ◽

Vol 13 (7) ◽

pp. 493

Author(s):

Harald Hefter ◽

Isabelle Schomaecker ◽

Max Schomaecker ◽

Dietmar Rosenthal ◽

Sara Samadzadeh

Keyword(s):

Botulinum Toxin ◽

Cervical Dystonia ◽

Age At Onset ◽

Term Outcome ◽

Long Term Outcome ◽

Course Of Disease ◽

Related Data ◽

Botulinum Toxin Therapy ◽

The Impact

This study analyses the influence of the course of the disease of idiopathic cervical dystonia (CD) before botulinum toxin (BoNT) therapy on long-term outcomes. 74 CD-patients who were treated on a regular basis in the botulinum toxin outpatient department of the University of Düsseldorf and had received at least 3 injections were consecutively recruited after written informed consent. Patients were asked to rate the amount of change of CD in relation to the severity of CD at begin of BoNT therapy (IMPQ). Then they had to draw the course of disease of CD from onset of symptoms until initiation of BoNT therapy (CoDB-graph) on a sheet of paper into a square of 10 × 10 cm2 size. Remaining severity of CD was estimated by the treating physician using the TSUI-score. Demographical and treatment related data were extracted from the charts of the patients. Depending on the curvature four different types of CoDB-graphs could be distinguished. Time to BoNT therapy, increase of dose and improvement during BoNT treatment were significantly (p < 0.05) different when patients were split up according to CoDB-graph types. The lower the age at onset of symptoms, the shorter was the time to therapy (p < 0.02). Initial dose (p < 0.04) and actual dose (p < 0.009) were negatively correlated with the age of the patients at recruitment. The course of disease of CD before BoNT therapy has influence on long-term outcome. This has implications on patient management and information on the efficacy of BoNT treatment.

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Long-term treatment with botulinum toxin type A in cervical dystonia has low immunogenicity by mouse protection assay

Movement Disorders ◽

10.1002/mds.22157 ◽

2008 ◽

Vol 23 (10) ◽

pp. 1353-1360 ◽

Cited By ~ 115

Author(s):

Mitchell F. Brin ◽

Cynthia L. Comella ◽

Joseph Jankovic ◽

Francis Lai ◽

Markus Naumann ◽

...

Keyword(s):

Botulinum Toxin ◽

Cervical Dystonia ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Term Treatment ◽

Protection Assay ◽

Long Term Treatment

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The Use of High Initial Doses of Botulinum Toxin Therapy for Cervical Dystonia Is a Risk Factor for Neutralizing Antibody Formation—A Monocentric Cross-Sectional Pilot Study

Medicina ◽

10.3390/medicina58010088 ◽

2022 ◽

Vol 58 (1) ◽

pp. 88

Author(s):

Harald Hefter ◽

Isabelle Schomaecker ◽

Max Schomaecker ◽

Dietmar Rosenthal ◽

Sara Samadzadeh

Keyword(s):

Botulinum Toxin ◽

Treatment Failure ◽

Cervical Dystonia ◽

Neutralizing Antibodies ◽

Neutralizing Antibody ◽

Rapid Onset ◽

Secondary Treatment ◽

Cross Sectional ◽

Number Of Patients ◽

Botulinum Toxin Therapy

Background and Objectives: The present study aims to analyze the complex patient/treating physician interaction at onset of botulinum toxin (BoNT) therapy in patients with idiopathic cervical dystonia (CD) and the influence of high initial doses on long-term outcomes. Materials and Methods: A total of 74 CD patients with well-documented courses of BoNT treatment were consecutively recruited after written informed consent. Patients had to rate the amount of improvement of CD in percent of severity of CD at onset of BoNT therapy. They had to draw the course of disease severity (CoD) of CD from the onset of symptoms until the onset of BoNT therapy and from the onset of BoNT therapy until recruitment. The remaining severity of CD was estimated by the treating physician using the TSUI score. Demographic- and treatment-related data were extracted from the charts of the patients. Seventeen patients with suspected secondary treatment failure (STF) were tested for the presence of antibodies. Results: Depending on the CoD before BoNT therapy, three patient subgroups could be distinguished: rapid onset, continuous onset and delayed onset groups. Time to BoNT therapy, increase in dose and improvement were significantly different between these three groups. In the rapid onset group, with the highest initial doses, the best improvement was reported, but the highest number of patients with an STF and with neutralizing antibodies was also observed. Conclusion: The use of high initial doses in the BoNT therapy of CD is associated with a rapid response and quick success; however, it leads to an elevated risk for the development of a secondary treatment failure and induction of neutralizing antibodies.

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The impact of isolated local recurrence on long-term outcome in early-breast cancer patients after breast-conserving therapy

European Journal of Cancer ◽

10.1016/j.ejca.2021.06.018 ◽

2021 ◽

Vol 155 ◽

pp. 28-37

Author(s):

Conny Vrieling ◽

Samson Y. Assele ◽

Lotte Moser ◽

Nicolas Sauvé ◽

Saskia Litière ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Cancer Patients ◽

Breast Conserving Therapy ◽

Breast Cancer Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Isolated Local Recurrence ◽

The Impact

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Sustained drug delivery optimizes long-term treatment of patients with schizophrenia

Acta Neuropsychiatrica ◽

10.1111/j.0924-2708.2004.00100.x ◽

2004 ◽

Vol 16 (6) ◽

pp. 319-325 ◽

Cited By ~ 2

Author(s):

Pierre S. Chue ◽

Peter D'Hoore ◽

J. Michael Ramstack

Keyword(s):

Antipsychotic Agents ◽

Term Treatment ◽

Treatment Programs ◽

Sustained Drug Delivery ◽

Partial Compliance ◽

Long Term Treatment ◽

Optimal Maintenance ◽

Long Acting ◽

The Impact

Chronic disorders such as schizophrenia require long-term treatment programs in order to maintain patients at the lowest level of symptomatology, reduce the likelihood of psychotic relapse, and support achievement of remission and recovery. Evidence suggests that treatment with long-acting injectable antipsychotics reduces the impact of partial compliance and provides predictable release of medication, assuring continuous therapeutic coverage. Until recently, only conventional antipsychotic agents were available in long-acting formulations, thereby foregoing the advantages of the atypical class. Atypical agents which are given orally have been shown to provide long-term efficacy and tolerability benefits compared with conventional agents, but are limited by the need for daily administration. The most recent pharmacological strategy to achieve optimal maintenance treatment has been to combine the benefits of an atypical antipsychotic with delivery in a water-based long-acting formulation. The first antipsychotic to achieve this combination – long-acting risperidone – may thus represent an important advance in the optimization of long-term treatment outcomes in patients with schizophrenia.

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Perinatal Care at the Threshold of Viability

PEDIATRICS ◽

10.1542/peds.96.5.974 ◽

1995 ◽

Vol 96 (5) ◽

pp. 974-976

Author(s):

◽

Keyword(s):

Perinatal Care ◽

Survival Rates ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

Term Outcome ◽

Long Term Outcome ◽

Obstetric Management ◽

The Cost ◽

The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

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Psychological profiles derived by cluster analysis of Minnesota Multiphasic Personality Inventory and long term clinical outcome after coronary artery by pass grafting

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2012.141 ◽

2015 ◽

Vol 78 (1) ◽

Author(s):

Maddalena Modica ◽

Roberta Carabalona ◽

Rosa Spezzaferri ◽

Monica Tavanelli ◽

A. Torri ◽

...

Keyword(s):

Cluster Analysis ◽

Coronary Artery ◽

Clinical Characteristics ◽

Minnesota Multiphasic Personality Inventory ◽

Personality Inventory ◽

Psychological Characteristics ◽

Term Outcome ◽

Long Term Outcome ◽

The Impact

Background: To evaluate the psychological characteristics of coronary heart disease (CHD) patients after coronary artery bypass grafting (CABG) by cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI-2) questionnaires and to assess the impact of the profiles obtained on long-term outcome. Methods: 229 CHD patients admitted to cardiac rehabilitation filled in self-administered MMPI-2 questionnaires early after CABG. We assessed the relation between MMPI- 2 profiles derived by cluster analysis, clinical characteristics and outcome at 3-year follow-up. Results: Among the 215 patients (76% men, median age 66 years) with valid criteria in control scales, we identified 3 clusters (G) with homogenous psychological characteristics: G1 patients (N=75) presented somatoform complaints but overall minimal psychological distress. G2 patients (N=72) presented type D personality traits. G3 subjects (N=68) showed a trend to cynicism, mild increases in anger, social introversion and hostility. Clusters overlapped for clinical characteristics such as smoking (G1 21%, G2 24%, G3 24%, p ns), previous myocardial infarction (G1 43%, G2 47%, G3 49% p ns), LV ejection fraction (G1 60 [51 – 60]; G2 58 [49- 60]; G3 60 [55-60], p ns), 3-vessel-disease prevalence (G1 69%, G2 65%, G3 71%, p ns). Three-year event rates were comparable (G1 15%; G2 18%; G3 15%) and Kaplan- Meier curves overlapped among clusters (p ns). Conclusions: After CABG, the interpretation of MMPI- 2 by cluster analysis is useful for the psychological and personological diagnosis to direct psychological assistance. Conversely, results from cluster analysis of MMPI-2 do not seem helpful to the clinician to predict long term outcome.

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