Abstract TP331: Effectiveness of AbobotulinumtoxinA in Stroke Survivors with Lower Limb Spasticity

Introduction and objective: Up to 40% of stroke survivors will develop spasticity that may affect their ability to walk or cause other issues such as pain. The aim of this observational study was to assess longitudinal goal attainment with repeated injections of abobotulinumtoxinA (aboBoNT-A) for the management of leg spasticity in a routine clinical setting. Methods: AboliSh was a 16-month observational study (NCT04050527) that followed ambulatory adults (≥18 years able to take ≥5 steps with/without assistance) with unilateral leg spasticity who were treated with aboBoNT-A according to local clinical guidelines to achieve personalized treatment goals. Post-hoc analyses of cumulative goal attainment (assessed using GAS-leg across all treatment cycles) were performed for stroke survivors who underwent ≥1 BoNT-A injection cycle and had ≥1 GAS assessment (n=328). Potential predictors of response during Cycle 1 (defined as achieving a GAS T score of ≥50 during Cycle 1) were analyzed using a stepwise multivariate logistic regression model. We subsequently performed subgroup analyses for cumulated GAS T scores, categorized by age. Results: At Cycle 1, the median total injected dose of aboBoNT-A for the lower limb was 600U [range 100-1500U], which was injected into a median of 4 muscles [1-8]. Overall, 64% of study participants also required injections for upper limb spasticity; in these cases the median total body dose was 1362.5 U. At the population level, goals were achieved as expected over repeated cycles. The mean [95% CI] cumulated GAS-leg T score at 16 months was 48.2 [47.5, 49.0] (median of 50). Change in cumulated GAS T scores were clinically relevant; the mean change in GAS-leg score was 9.9 [9.1, 10.7] (median of 10). While age was found to be a significant prognostic factor in GAS-T response in Cycle 1 (p=0.03); mean±SD [median] cumulated GAS T scores were similar in the age subgroups of <50y: 49.4±7.1 [50] (n=103); 50-60y: 47.7±7.5 [50] (n=96); and >60y: 47.7±6.8 [50] (n=129). Conclusions: Results from this prospective, longitudinal study demonstrate the sustained functional benefit of repeated cycles of aboBoNT-A, as assessed by person-centered goal attainment.