Evaluate how regional variations in the use of instrumental injection guidance for abobotulinumtoxinA (aboBoNT-A) impact the achievement of functional goals in patients with leg spasticity.

We previously reported the primary effectiveness outcomes from a large real-world study that tracked longitudinal goal attainment in ambulatory adults following ≥1 aboBoNT-A injection for lower limb spasticity. Overall, patients achieved their primary goals, with a mean cumulative GAS-leg T score of 48.2 [95%CI: 47.4, 48.9]. Patients who received injections using instrumented guidance techniques (electromyography, electrostimulation, and/or ultrasound) at baseline were significantly more likely to achieve their primary treatment goals during Cycle 1 compared to those treated without such guidance (odds ratio: 1.9 [95%CI: 1.1, 3.1], p = 0.02).

Post-hoc analysis of the AboLiSh observational study (NCT04050527). Subgroups were defined according to region: Eastern Europe and Central Asia [EECA] (n=136), Europe (n=132), and North America (n=89), and analyzed separately for the primary effectiveness endpoint (cumulative GAS-leg T score). We also evaluated the use of injection guidance at Cycle 1 per region.

The use of instrumented injection guidance during Cycle 1 varied considerably across the three regions: 95.6% in EECA, 84.8% in Europe, and 52.8% in North America. Goal attainment was significantly higher in the EECA subgroup, with a mean GAS-leg T score of 50.7 (95%CI: 50.0, 51.4), compared to the European subgroup of 47.8 [46.4, 49.1]; p=0.0001, which in turn outperformed the North American subgroup of 44.5 [42.6, 46.3]; p=0.004. Similarly, the proportion of responders (defined as those with a GAS T score ≥50 at end of Cycle 1) was highest in EECA (75.0%), followed by Europe (54.5%) and North America (34.8%).

Regional analyses reinforce the overall study findings, demonstrating that goal attainment was higher among patients who received injection guidance during Cycle 1 compared to those who did not.