In the US, onabotulinumtoxinA is approved for the treatment of 12 therapeutic indications, but long-term real-world safety and utilization data for treatment of concomitant multiple indications are limited.

279 patients were treated for ≥2 different therapeutic indications across analyzed treatment indication combination groups (Period 1; mean age, 49.2y; 79% female; 56% White) and gradually decrease to 80 patients during the last TP (Period 7). Mean treatments over the study were 9.3 (range 2-48); most common combination was cervical dystonia and chronic migraine (range 34-44%). No significant change in comorbidities and concomitant medications were observed over repeat TPs. 28.7% (80/279) patients reported ≥1 treatment-emergent adverse event (TEAE) after Period 1; this proportion remained broadly constant after each TP; 29.7%, 29.6%, and 31.3% after Periods 3, 5 and 7, respectively. Most common TEAEs were UTI (range 0.7-5.7%), neck pain (range 3.7-9.1%), headache (range 2.9-6.5%), and migraine (range 2.5-6.4%). Most patients had a dosage interval (time between multiple indications treatments) of ≤24h (range 62-98%) and received ≥200-<400U of cumulative 3-months dose for multiple indications (range 43-50%). Mean total 3-month dose ranged from 232-287U. No trend was observed between TEAE incidence and dosage intervals or cumulative 3-month dose over the study period. No patients showed lack of effect based on clinical objective measurement.