TY  - JOUR
AU  - Walter, Uwe
AU  - Albrecht, Phillipp
AU  - Carr, Warner
AU  - Hefter, Harald
TI  - Systematic Review and Meta-Analysis of Secondary Treatment Failure and Immunogenicity With Botulinum Neurotoxin A in Multiple Indications.
JO  - European journal of neurology
VL  - 32
IS  - 8
SN  - 1351-5101
CY  - Oxford [u.a.]
PB  - Wiley-Blackwell
M1  - DZNE-2025-00919
SP  - e70289
PY  - 2025
AB  - Botulinum neurotoxin A (BoNT-A) is recommended for the treatment of cervical dystonia (CD), spasticity, and blepharospasm. Some patients treated with BoNT-A have been reported to develop neutralizing antibodies (NAbs) against BoNT-A, which may result in reduced efficacy and, in some cases, secondary treatment failure (STF). Our aim was to investigate the incidence of STF and NAb positivity after treatment with one of three commercially-available BoNT-A formulations.A systematic review and meta-analysis of STF and/or NAb positivity after treatment with abobotulinumtoxinA, incobotulinumtoxinA, or onabotulinumtoxinA in patients with CD, spasticity, or blepharospasm was conducted using PubMed, Embase, and Google Scholar.Twenty-nine unique studies reported in 29 publications assessed NAb positivity and were included. The meta-analysis showed that the proportions of patients developing STF were significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. Depending on the antibody test used, the proportions of patients developing NAbs were also significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. When data for all indications were pooled, proportions of NAb-positive patients were numerically higher with increasing mean doses of abobotulinumtoxinA or onabotulinumtoxinA. No patients treated exclusively with incobotulinumtoxinA were found to have developed immunogenic STF or persistent NAbs.The risk of developing STF and NAbs appears to vary with indication and BoNT-A formulation. When the efficacy and safety of formulations are comparable, incobotulinumtoxinA may be recommended to avoid developing STF and immunogenicity, particularly for patients requiring higher doses and repeated treatments.
KW  - Humans
KW  - Botulinum Toxins, Type A: therapeutic use
KW  - Botulinum Toxins, Type A: immunology
KW  - Botulinum Toxins, Type A: adverse effects
KW  - Muscle Spasticity: drug therapy
KW  - Muscle Spasticity: immunology
KW  - Torticollis: drug therapy
KW  - Torticollis: immunology
KW  - Treatment Failure
KW  - Antibodies, Neutralizing: blood
KW  - Antibodies, Neutralizing: immunology
KW  - Neuromuscular Agents: immunology
KW  - Neuromuscular Agents: therapeutic use
KW  - Blepharospasm: drug therapy
KW  - Blepharospasm: immunology
KW  - blepharospasm (Other)
KW  - botulinum toxin (Other)
KW  - cervical dystonia (Other)
KW  - immunogenicity (Other)
KW  - spasticity (Other)
KW  - Botulinum Toxins, Type A (NLM Chemicals)
KW  - Antibodies, Neutralizing (NLM Chemicals)
KW  - Neuromuscular Agents (NLM Chemicals)
KW  - abobotulinumtoxinA (NLM Chemicals)
KW  - incobotulinumtoxinA (NLM Chemicals)
KW  - onabotulinum toxin A (NLM Chemicals)
LB  - PUB:(DE-HGF)16
C6  - pmid:40729416
C2  - pmc:PMC12306683
DO  - DOI:10.1111/ene.70289
UR  - https://pub.dzne.de/record/280241
ER  -