The Impact of OnabotulinumtoxinA on Oral Pain Medication Prescription Fills and Low-Value Care in Patients with Cervical Dystonia in the United States: A Retrospective Claims Analysis

(1) Background: While evidence supporting the use of onabotulinumtoxinA in patients with cervical dystonia (CD) is well-established, more evidence is needed to understand if onabotulinumtoxinA treatment can reduce reliance on addictive medication. (2) Methods: This retrospective study used claims data to evaluate the impact of onabotulinumtoxinA treatment on opioid, benzodiazepine (BZD), and skeletal muscle relaxant (SMR) prescription fills among patients diagnosed with CD with prior use of these medications. Among the 564 eligible patients, three non-mutually exclusive cohorts were identified based on medication use data: opioid (n = 306), BZD (n = 271), and SMR (n = 371). The follow-up period continued for 12 months after onabotulinumtoxinA treatment initiation. (3) Results: Among patients with >1 opioid fill at baseline, 30.4% had no opioid fills in the 12-month period following onabotulinumtoxinA initiation. The opioid cohort had significantly reduced mean opioid prescription fills per patient (17.0%; p < 0.0001) in the follow-up period compared with baseline. A 30.0% decrease was observed in the mean morphine milligram equivalent (MME)/day after onabotulinumtoxinA initiation (p < 0.0001). Similar trends of decreased BZD and SMR prescription fills were observed. (4) Conclusions: Following initiation of onabotulinumtoxinA treatment, patients living with CD who had prior opioid, BZD, or SMR use had significant reductions in respective prescription fills for opioids, BZDs, and SMRs.