Objective:

We evaluated the impact of onabotulinumtoxinA treatment on opioid, skeletal muscle relaxant (SMR), and benzodiazepine (BZD) use among patients diagnosed with cervical dystonia (CD) with prior use of these medications.

Background:

OnabotulinumtoxinA is the only botulinum toxin indicated to treat abnormal head position and neck pain in cervical dystonia.

Design/Methods:

This retrospective cohort analysis evaluated claims from January 2017-December 2023 using medical and pharmacy claims data. Three cohorts were identified based on medication use data from eligible CD-diagnosed patients during the 12 months prior to onabotulinumtoxinA treatment initiation (index date): opioid, SMR, and BZD cohorts. The follow-up period continued for 12 months from the index date. Changes in number of opioid, SMR, and BZD prescription fills and opioid daily dose per patient (morphine milligram equivalent [MME]/day) were assessed in respective cohorts.

Results:

564 eligible patients were identified, with non-mutually exclusive opioid (n=306), SMR (n=371), and BZD (n=271) cohorts. Patient characteristics were similar across cohorts, with the overall average patient being white (64.9%), female (71.6%), and 58.1 years old. Among patients with >1 opioid fill at baseline (opioid cohort), 30.4% had no opioid fills in the 12-month period following onabotulinumtoxinA initiation. The opioid cohort had significantly reduced mean opioid prescription fills per patient (17.0%; p<0.001) in the follow-up period compared with baseline. A 30.0% decrease was observed in mean MME/day after onabotulinumtoxinA initiation (p<0.001). Similarly decreased SMR and BZD utilization trends were observed. Following onabotulinumtoxinA initiation, 34.2% of the SMR cohort and 32.5% of the BZD cohort had no SMR or BZD prescription fills, respectively.

Conclusions:

Patients with CD and prior opioid, SMR, and/or BZD use had significantly reduced opioid, SMR, and BZD utilization, respectively, for 12 months after initiating onabotulinumtoxinA compared with the preceding 12-month period. OnabotulinumtoxinA is indicated to reduce CD-related pain and may reduce opioid use in patients.