Long-term incobotulinumtoxinA treatment for chronic sialorrhea: Efficacy and safety over 64 weeks. (January 2020)

• Record Type: Journal Article
• Authors: Jost, Wolfgang H.; Friedman, Andrzej; Michel, Olaf; Oehlwein, Christian; Slawek, Jaroslaw; Bogucki, Andrzej; Ochudlo, Stanislaw; Banach, Marta; Pagan, Fernando; Flatau-Baqué, Birgit; Dorsch, Ulrike; Csikós, János; Blitzer, Andrew
• Is Part Of: Parkinsonism & related disorders. Volume 70(2020)
• Page Start: 23
• Page End: 30
• Publication Date: 2020-01
• Subjects: Botulinum toxin -- Parkinson's disease/Parkinsonism -- Drooling -- IncobotulinumtoxinA -- Sialorrhea; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2019.11.024
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking. This study investigated the efficacy and safety of repeated incobotulinumtoxinA injections for chronic sialorrhea over 64 weeks. Methods: Adults with sialorrhea were randomized (2:2:1) to incobotulinumtoxinA 75 U, incobotulinumtoxinA 100 U (n = 74 each), or placebo (n = 36) in the double-blind, placebo-controlled main period (NCT02091739). Eligible subjects entered the extension period and received dose-blinded incobotulinumtoxinA 75 or 100 U in three further 16±2-week injection cycles. Efficacy and safety assessments in subjects who received incobotulinumtoxinA throughout the study included unstimulated salivary flow rate (uSFR), subjects' Global Impression of Change Scale (GICS), Drooling Severity and Frequency Scale (DSFS), modified Radboud Oral Motor Inventory for Parkinson's Disease (mROMP) drooling, speech, and swallowing symptom scores, and incidence of adverse events (AEs). Results: In total, 173/184 subjects (94%) completed the main period and entered the extension period; 141 subjects received incobotulinumtoxinA 75 U (n = 69) or 100 U (n = 72) in both periods. Mean uSFR decreased consistently with repeated incobotulinumtoxinA 75 and 100 U treatment and by −0.16 and −0.17, respectively, at the end-of-study visit. Subjects' GICS, DSFS, and mROMP drooling scores also improved at all assessments. mROMP speech and swallowing scores remained stable. The most common treatment-related AEs during the extension period were dry mouth (4.4% and 11.1%) and dysphagia (1.5% and 4.2%). Conclusions: Data support long-term efficacy and safety of repeated incobotulinumtoxinA treatment for sialorrhea, with no additional safety concerns reported over 64 weeks. Highlights: IncobotulinumtoxinA 75 or 100 U efficacy for chronic sialorrhea over 64 weeks. Consistent reduction in unstimulated salivary flow rate with both doses. Increasing improvements in clinical outcomes with repeated treatment over time. Well-tolerated, no additional safety concerns reported over 64 weeks of treatment. Comparable efficacy and safety with ultrasound or anatomical landmark-guidance.