# REAL-WORLD USE OF BOTULINUM TOXIN-A FOR POST-STROKE SPASTICITY IN THE NETHERLANDS: A RETROSPECTIVE CLAIMS STUDY

## TL;DR

A study in the Netherlands found that only 1.7% of stroke patients with muscle stiffness received botulinum toxin-A injections, suggesting underuse and inconsistent treatment patterns.

## Contribution

This study provides real-world data on botulinum toxin-A usage for post-stroke spasticity in the Netherlands using nationwide insurance claims.

## Key findings

- Only 1.7% of stroke patients with spasticity received botulinum toxin-A treatment.
- Most patients received only 1 or 2 injection cycles, with wide variation in treatment intervals and doses.
- OnabotulinumtoxinA was used more frequently than abobotulinumtoxinA.

## Abstract

The aim of this observational study was to describe the real-world use of botulinum toxin-A in patients with a stroke in the Netherlands.

This study used longitudinal insurance claims data between 2012 and 2016 with 30% nationwide coverage and included patients with both stroke-related and botulinum toxin-A claims. All analyses were descriptive and displayed as summary statistics.

60,222 patients with a stroke were identified, of whom 18,141 (30.1%) were treated in a rehabilitation centre or hospital and 1.7% (1,036 patients) were treated with botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients were included in the analysis (1.5% of all patients in the database). Mean age was 63.4 (SD ± 14.0) years at index injection cycle, with a median follow-up of 3.7 years (interquartile range [IQR] 2.2–4.5 years). Patients received up to 16 injection cycles with a median of 2 injection cycles (IQR 1–5 cycles). The median Time-To-Next-Injection-Cycle was 17 weeks (IQR 13–25 weeks). The total number of injection cycles was 604 for abobotulinumtoxinA (22.1%) and 2,251 (78.8%) for onabotulinumtoxinA. Doses per cycle ranged from 200–660 for abobotulinumtoxinA and 101–400 units for onabotulinumtoxinA.

Claims data from a national healthcare insurance fund in the Netherlands showed that only 1.7% of patients with post-stroke spasticity received botulinum toxin-A. Botulinum toxin-A treatment doses and intervals varied widely across patients and most patients received only 1 or 2 botulinum toxin-A injection cycles. Our results suggest undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in Dutch clinical practice.

After a stroke, patients can experience muscle stiffness, which is known as post-stroke spasticity. Botulinum toxin-A injections are commonly used to reduce symptoms, but real-world treatment patterns are not well studied. This study examined how botulinum toxin-A is used in patients with post-stroke spasticity in the Netherlands using insurance claims from 2012–2016. Of 60,222 patients with a stroke, only 1.7% were treated with botulinum botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients (1.5% of all patients in the database) were included in this study. These patients had an average age of 63.4 years at the time of the first botulinum toxin-A injection. Patients received up to 16 treatment cycles, with an average of 2 cycles and an interval of 17 weeks between cycles. Two formulations of botulinum toxin-A were available in the Netherlands between 2012 and 2016. Most patients (76.9%) received onabotulinum toxin-A at an average dose of 290 units, while the remaining patients received abobotulinum toxin-A at an average dose of 500 units. It is important to note that the dosing recommendations for onabotulinum toxin-A and abobotulinum toxin-A differ and cannot be directly compared. This study suggests potential undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in the Netherlands.