Neuropediatrics 2018; 49(S 02): S1-S69
DOI: 10.1055/s-0038-1676031
Industrial Posters
Epilepsy and Movement Disorders
Georg Thieme Verlag KG Stuttgart · New York

IP 467. Botulinum Toxin Type A in the Management of Spasticity in Children—A Systematic Literature Review and Bayesian Network Meta-analysis

P. Guyot
1   Mapi Group, Lyon, France
,
C. Kalyvas
2   Mapi Group, Houten, The Netherlands
,
L Weijers
2   Mapi Group, Houten, The Netherlands
,
A. Karabis
2   Mapi Group, Houten, The Netherlands
,
N. Danchenko
3   Ipsen Pharma, Boulogne-Billancourt, France
› Author Affiliations
Further Information

Publication History

Publication Date:
30 October 2018 (online)

 

Background: Botulinum toxin type A (BoNT-A) is used in the management of pediatric lower limb spasticity to improve function and to prevent or delay musculoskeletal complications. In the absence of head-to-head evidence, this meta-analysis evaluated the relative efficacy and safety of different BoNT-A formulations used in pediatric spasticity management.

Methods: A systematic literature review was conducted (March 2016) to identify all relevant randomized controlled trials. The evidence base was synthesized by means of Bayesian network meta-analyses. Scenario analyses included standardized mean differences (SMD). Clinical end points were: modified Ashworth scale (MAS), Tardieu scale-spasticity grade, and goal attainment scale (GAS) (SMD only) at 12 weeks postinjection and any adverse events.

Results: Of the 38 studies identified, 10 met criteria for quantitative synthesis. Improvements in muscle tone (MAS) were significantly better with abobotulinumtoxinA 15 U/kg/leg versus onabotulinumtoxinA 4 U/kg/leg (−0.99 [−1.49; −0.50]), onabotulinumtoxinA 4 U/kg/leg +casting (−0.81 [−1.30; −0.32]), and numerically better than onabotulinumtoxinA 8 U/kg (−0.70 [−1.64; 0.22], Pbetter = 93%). Goal achievement (GAS) with abobotulinumtoxinA 15 U/kg/leg was numerically better than onabotulinumtoxinA 12 U/kg/leg. AbobotulinumtoxinA 15 U/kg/leg showed the highest SUCRA value on MAS and GAS. Efficacy on the Tardieu scale was comparable between treatments. AbobotulinumtoxinA had comparable or fewer adverse events than onabotulinumtoxinA 4 U/kg/leg.

Conclusion: Our analyses suggest that abobotulinumtoxin A offers a comparable or favorable efficacy on tone (MAS), spasticity (Tardieu scale), functional outcomes (GAS), and tolerability versus onabotulinumtoxinA, in the management of children with lower limb spasticity. The results must be interpreted in the context of the heterogenity of the evidence base and sparse evidence base.