(Research Hub Theater) Analysis of Path of Therapy in the Treatment of Spasticity in Adult Post-stroke Patients

Background and/or Objectives: Post-stroke spasticity (PSS) occurs in ~25-43% of patients between 2 weeks-3 months following a stroke. Treatment guidelines recommend botulinum toxin-A (BoNT-A) as first-line treatment for management of PSS based on robust evidence (level A). We examined pharmacological treatment patterns for spasticity following hospitalization post-stroke in adults over a 2-year follow-up period.

Design: Retrospective healthcare claims study.

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

Participants: Patients were 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: not applicable.

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

Results: Overall, 7,851 patients fulfilled study criteria; 975 patients (12.4%) had PSS and 911 (11.6%) received PSS pharmacotherapy, with a mean±SD time to initiating first-line treatment observed at 270±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 a 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.