Abobotulinumtoxin A for equinus foot deformity in cerebral palsy: A randomized controlled trial

Mauricio R. Delgado, Ann Tilton, Barry Russman, Oscar Benavides, Marcin Bonikowski, Jorge Carranza, Edward Dabrowski, Nigar Dursun, Mark Gormley, Marek Jozwiak, Dennis Matthews, Iwona Maciag-Tymecka, Ece Unlu, Emmanuel Pham, Anissa Tse, Philippe Picaut

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29 Scopus citations

Abstract

BACKGROUND: Although botulinum toxin is a well-established treatment of focal spasticity in cerebral palsy, most trials have been small, and few have simultaneously assessed measures of muscle tone and clinical benefit. METHODS: Global, randomized, controlled study to assess the efficacy and safety of abobotulinumtoxinA versus placebo in cerebral palsy children with dynamic equinus foot deformity. Patients were randomized (1:1:1) to abobotulinumtoxinA 10 U/kg/leg, 15 U/kg/ leg, or placebo injections into the gastrocnemius-soleus complex (1 or both legs injected). In the primary hierarchical analysis, demonstration of benefit for each dose required superiority to placebo on the primary (change in Modified Ashworth Scale from baseline to week 4) and first key secondary (Physician's Global Assessment at week 4) end points. RESULTS: Two hundred and forty-one patients were randomized, and 226 completed the study; the intention to treat population included 235 patients (98%). At week 4, Modified Ashworth Scale scores significantly improved with abobotulinumtoxinA; mean (95% confidence interval) treatment differences versus placebo were -0.49 (-0.75 to -0.23; P = .0002) for 15 U/kg/leg and -0.38 (-0.64 to -0.13; P = .003) for 10 U/kg/leg. The Physician's Global Assessment treatment differences versus placebo of 0.77 (0.45 to 1.10) for 15 U/ kg/leg and 0.82 (0.50 to 1.14) for 10 U/kg/leg were also significant (both Ps < .0001). The most common treatment-related adverse event was muscular weakness (10 U/Kg/leg = 2; placebo = 1). CONCLUSIONS: AbobotulinumtoxinA improves muscle tone in children with dynamic equinus resulting in an improved overall clinical impression and is well tolerated.

Original languageEnglish (US)
Article numbere20152830
JournalPediatrics
Volume137
Issue number2
DOIs
StatePublished - Feb 2016

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Delgado, M. R., Tilton, A., Russman, B., Benavides, O., Bonikowski, M., Carranza, J., Dabrowski, E., Dursun, N., Gormley, M., Jozwiak, M., Matthews, D., Maciag-Tymecka, I., Unlu, E., Pham, E., Tse, A., & Picaut, P. (2016). Abobotulinumtoxin A for equinus foot deformity in cerebral palsy: A randomized controlled trial. Pediatrics, 137(2), [e20152830]. https://doi.org/10.1542/peds.2015-2830