A mixed treatment comparison on efficacy and safety of treatments for spasticity caused by multiple sclerosis: a systematic review and network meta-analysis

Fu, Xiaohong; Wang, Yanqiao; Wang, Can; Wu, Huihui; Li, Jinyao; Li, Ming; Ma, Qianqian; Yang, Wei

doi:10.1177/0269215517745348

Cited by 25 publications

(30 citation statements)

References 29 publications

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“…Research of oral BZs in spasticity is mixed and insufficient [68][69][70][71], however, and when benefit was seen, comparison trials favored other agents for functional and tolerability reasons [68,[72][73][74][75][76]. In a metaanalysis of 23 trials (total N = 2720), diazepam was not recommended for spasticity in multiple sclerosis because of side effects and greater efficacy found with cannabinoids, botulinum toxin, and transcutaneous electrical stimulation [77]. Note that spasticity trials were not designed to examine pain endpoints so no firm conclusions can be drawn about analgesic efficacy [71].…”

Section: Benzodiazepine Use For Analgesiamentioning

confidence: 99%

Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review

Wright¹

2020

Adv Ther

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Introduction: Controversy and uncertainty exist about the use of benzodiazepine receptor agonists (BZRAs) in pain management. This article curates available research to determine the appropriate role of BZRAs in the course of pain management, and how prescribers might address these challenges. Methods: A narrative review was performed to determine the appropriate role of BZRAs in pain management and to develop practice recommendations. Publications were identified by a search of PubMed, references of retrieved reports, guidelines, and the author's personal files. Results: BZRAs were found to have analgesic benefit for two pain conditions: burning mouth syndrome and stiff person syndrome. Absence of research, heterogeneity of trials, and small sample sizes precluded drawing conclusions about efficacy of BZRAs for the other 109 pain conditions explored. Data supports the use of BZRAs to treat co-occurring insomnia and anxiety disorders but only when alternatives are inadequate and only for short periods of time (2-4 weeks). The utility of BZRAs is limited by loss of efficacy that may be seen with continued use and adverse reactions including physiologic dependence which develops in 20-100% of those who take these agents for more than a month. Conclusions: BZRAs are often used inappropriately in pain management. Their initiation and duration of use should be limited to a narrow range of conditions. When prescribed for 4 weeks or more, patients should be encouraged to discontinue them through a supported, slow tapering process that may take 12-18 months or longer.

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Section: Benzodiazepine Use For Analgesiamentioning

confidence: 99%

Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review

Wright¹

2020

Adv Ther

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“…BTX-A has long been used in the symptomatic treatment of MS patients, such as for a hyperactive bladder [46]. Likewise, studies and reviews [47][48][49] have reported BTX-A use for the treatment of spasticity, but few randomised trials have been performed. In this regard, the review by Dressler et al 2017 [49] found only three RCTs [50][51][52], and a recent Italian consensus on spasticity treatment considered only 4 trials concerning BTX [53].…”

Section: Multiple Sclerosismentioning

confidence: 99%

“…Among BTX-A formulations, aboBTX-A and onaBTX-A were predominantly injected to treat spasticity, apart from in one study with mixed samples that used incoBTX-A [39] neurotoxin. All studies showed a significant efficacy of BTX in reducing spasticity due to MS [47][48][49]. BTX-A dosages up to 2000 UI for Dysport [56,57] and up to 400 UI for Botox were injected without significant side effects.…”

Section: Multiple Sclerosismentioning

confidence: 99%

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Intiso

Simone

Bartolo³

et al. 2020

Toxins

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Spasticity is a common disabling disorder in adult subjects suffering from stroke, brain injury, multiple sclerosis (MS) and spinal cord injury (SCI). Spasticity may be a disabling symptom in people during rehabilitation and botulinum toxin type A (BTX-A) has become the first-line therapy for the local form. High BTX-A doses are often used in clinical practice. Advantages and limitations are debated and the evidence is unclear. Therefore, we analysed the efficacy, safety and evidence for BTX-A high doses. Studies published from January 1989 to February 2020 were retrieved from MEDLINE/PubMed, Embase, Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term “high dosage” indicated ≥ 600 U. Thirteen studies met the inclusion criteria. Studies had variable method designs, sample sizes and aims, with only two randomised controlled trials. IncoBTX-A and onaBTX-A were injected in three and eight studies, respectively. BTX-A high doses were used predominantly in treating post-stroke spasticity. No studies were retrieved regarding treating spasticity in MS and SCI. Dosage of BTX-A up to 840 U resulted efficacious and safety without no serious adverse events (AEs). Evidence is insufficient to recommend high BTX-A use in clinical practice, but in selected patients, the benefits of high dose BTX-A may be clinically acceptable.

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“…This phenomenon translates into BoNTs being an effective treatment for a variety of movement disorders and other neurological and non-neurological conditions. Several studies have indicated its effectiveness in the treatment of disorders such as dystonia, post stroke spasticity, and cerebral palsy to name a few [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. The side effect profile of long-term botulinum toxin injections has been well documented, especially in individuals with dystonia and spasticity [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have indicated its effectiveness in the treatment of disorders such as dystonia, post stroke spasticity, and cerebral palsy to name a few [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. The side effect profile of long-term botulinum toxin injections has been well documented, especially in individuals with dystonia and spasticity [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. A retrospective longitudinal descriptive analysis by Ramirez-Castenada et al of 89 subjects with dystonia showed that the most common side effects were dysphagia, ptosis, and neck weakness which has been duplicated in several other studies [ 3 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin Induced Atrophy: An Uncharted Territory

Salari

Sharma

Jog

2018

Toxins

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Botulinum neurotoxins (BoNTs) produce local chemo-denervation by cleaving soluble N-ethylmaleimide-sensitive factor activating protein receptor (SNARE) proteins. Botulinum neurotoxins are therapeutically indicated in several neurological disorders and have been in use for three decades. The long-term efficacy, safety, and side effects of BoNTs have been well documented in the literature. However, the development of muscle atrophy following chronic exposure to BoNTs has not received sufficient attention. Muscle atrophy is not only cosmetically distressing, but also has an impact on future injections. An extensive literature search was conducted on atrophy and mechanisms of atrophy. Five hundred and four relevant articles in the English language were reviewed. This review revealed the surprising lack of documentation of atrophy within the literature. In addition, as demonstrated in this review, the mechanisms and the clinical factors that may lead to atrophy have also been poorly studied. However, even with this limited information it is possible to indicate factors that could modify the clinical approach to botulinum toxin injections. This review highlights the need for further study of atrophy following BoNT injections.

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A mixed treatment comparison on efficacy and safety of treatments for spasticity caused by multiple sclerosis: a systematic review and network meta-analysis

Abstract: We recommended botulinum toxin as the optimal intervention for multiple sclerosis-related spasticity. Cannabinoids and transcutaneous electric nerve stimulation could also be considered as multiple sclerosis-related spasticity treatments but their safety remained to be verified.

Cited by 25 publications

References 29 publications

Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review

Limited Utility for Benzodiazepines in Chronic Pain Management: A Narrative Review

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Botulinum Toxin Induced Atrophy: An Uncharted Territory

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