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@ARTICLE{Walter:280241,
      author       = {Walter, Uwe and Albrecht, Phillipp and Carr, Warner and
                      Hefter, Harald},
      title        = {{S}ystematic {R}eview and {M}eta-{A}nalysis of {S}econdary
                      {T}reatment {F}ailure and {I}mmunogenicity {W}ith
                      {B}otulinum {N}eurotoxin {A} in {M}ultiple {I}ndications.},
      journal      = {European journal of neurology},
      volume       = {32},
      number       = {8},
      issn         = {1351-5101},
      address      = {Oxford [u.a.]},
      publisher    = {Wiley-Blackwell},
      reportid     = {DZNE-2025-00919},
      pages        = {e70289},
      year         = {2025},
      abstract     = {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.},
      subtyp        = {Review Article},
      keywords     = {Humans / Botulinum Toxins, Type A: therapeutic use /
                      Botulinum Toxins, Type A: immunology / Botulinum Toxins,
                      Type A: adverse effects / Muscle Spasticity: drug therapy /
                      Muscle Spasticity: immunology / Torticollis: drug therapy /
                      Torticollis: immunology / Treatment Failure / Antibodies,
                      Neutralizing: blood / Antibodies, Neutralizing: immunology /
                      Neuromuscular Agents: immunology / Neuromuscular Agents:
                      therapeutic use / Blepharospasm: drug therapy /
                      Blepharospasm: immunology / blepharospasm (Other) /
                      botulinum toxin (Other) / cervical dystonia (Other) /
                      immunogenicity (Other) / spasticity (Other) / Botulinum
                      Toxins, Type A (NLM Chemicals) / Antibodies, Neutralizing
                      (NLM Chemicals) / Neuromuscular Agents (NLM Chemicals) /
                      abobotulinumtoxinA (NLM Chemicals) / incobotulinumtoxinA
                      (NLM Chemicals) / onabotulinum toxin A (NLM Chemicals)},
      cin          = {AG Storch},
      ddc          = {610},
      cid          = {I:(DE-2719)5000014},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40729416},
      pmc          = {pmc:PMC12306683},
      doi          = {10.1111/ene.70289},
      url          = {https://pub.dzne.de/record/280241},
}