Tiburtius, Christian;
Böthig, Ralf;
Kowald, Birgitt;
Hirschfeld, Sven;
Thietje, Roland
Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury?
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Medientyp:
E-Artikel
Titel:
Can clinical and urodynamic parameters predict the occurrence of neutralizing antibodies in therapy failure of intradetrusor onabotulinumtoxin A injections in patients with spinal cord injury?
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>The aim of the study was to clarify whether clinical and/or urodynamic parameters could be used to infer the probability of neutralizing antibody (NAb) formation as a possible cause of therapy failure (non-response, NR) in patients with neurogenic detrusor overactivity (NDO) due to acquired spinal cord injury/disease (SCI/D) treated with intradetrusor botulinum neurotoxin A (BoNT-A) injections.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>A retrospective chart review was performed of all patients with SCI/D who underwent both intradetrusor onabotulinumtoxin A injections and the determination of neutralizing antibodies against BoNT-A between January 1, 2002, and December 31, 2018. NR was defined as urodynamically confirmed persistent or reappearing NDO.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>A total of 2700 BoNT-A injections in 414 patients were ascertained. In 69 patients with primary NR after the first BoNT-A injection (<jats:italic>n</jats:italic> = 6) or with secondary NR after more than one BoNT-A injection (<jats:italic>n</jats:italic> = 63), an antibody analysis was performed. Antibody examination showed 36 (52.2%) negative, 5 (7.2%) borderline and 14 (each 20.3%) each of positive and highly positive values. Subgroup analysis indicated a correlation between NAb formation and the duration of BoNT-A therapy (<jats:italic>p</jats:italic> = 0.015), the mean number of BoNT-A injections (<jats:italic>p</jats:italic> = 0.011) and the time interval between BoNT-A applications (< 7 months, <jats:italic>p</jats:italic> = 0.022). Urodynamic data analysis indicate significant differences with cut-off values of MCC (< 225 ml, <jats:italic>p</jats:italic> = 0.038) and MDP (> 45 cmH<jats:sub>2</jats:sub>O, <jats:italic>p</jats:italic> = 0.040). However, in the regression analysis models, the predictive value for the occurrence of NAb was too low (MCC: ROC AUC 0.62, MDP: ROC AUC 0.52) to distinguish with sufficient certainty between NAb-positive and NAb-negative NR patients.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Despite significant correlations, clinical and urodynamic parameters are only partially suitable for predicting antibody formation against BoNT-A.</jats:p>
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