Analysis of Path of Therapy in the Treatment of Spasticity in Adult Post-Stroke Patients

Research Objectives: To examine pharmacological treatment patterns for spasticity following hospitalization post-stroke in adults over a 2-year follow-up period.

Design: Retrospective, observational claims study.

Setting: IQVIA PharMetrics® Plus database of commercially/self-insured members from 10/01/2015-01/31/2021.

Participants: Adult patients selected based on two ICD-10 diagnosis codes for stroke requiring an inpatient stay (index date) with 12 months of continuous enrollment with medical/pharmacy benefits before the index date (pre-index) and 24 months starting on the index date (post-index), excluding patients with prior stroke or spasticity.

Interventions: N/A

Main Outcome Measures: Treatment patterns in post-stroke spasticity (PSS) pharmacotherapy, defined as prescription fill for an oral muscle relaxant or use of BoNT-A during the post-index period were assessed. A linear regression model (multivariate analysis) was developed to evaluate predictors of initiation of BoNT-A therapy.

Results: Overall, 7,851 patients fulfilled study criteria; 911 patients (11.6%) required PSS pharmacotherapy during the follow-up period, with a mean±SD time to initiating first-line treatment observed at 269±214 days. Most patients requiring pharmacotherapy used muscle relaxants as initial treatment (n=881; 97.0%); BoNT-A was used in 60 patients (6.6%), with nearly half (n=26) receiving BoNT-A first-line. On average, patients treated with BoNT-A received 3 injections, starting 319 days (mean) post-stroke, and 41 patients (68.0%) remained on treatment after 12 months. Multivariate analysis revealed previous use of muscle relaxants, benzodiazepines, antidepressants, or physical therapy was associated with a higher incidence of BoNT-A use.

Conclusions: In a cohort of patients hospitalized post-stroke, 11.6% required pharmacotherapy (BoNT-A or an oral muscle relaxant) within a 2-year follow-up. Although BoNT-A is recommended as first-treatment for spasticity, it was utilized in only 6.6% of PSS patients.

Author(s) Disclosures: MH, VRA, and MD: Employees of IQVIA, contracted by Ipsen to conduct this study; JM and JB: Employees of Ipsen.