Journal of Rehabilitation Medicine 51-10 | Page 96

P. J. McAllister et al.
UL symmetry of movement in gait and speed, whereas
this study included all UL muscles. This may explain
why patients with simultaneous injections showed less
improvement than those injected only in the LL, and
could suggest that specific UL muscles need to be tar-
geted to improve walking speed and gait. This analysis
provides initial data on split dosing of aboBoNT-A
when injecting LL and UL simultaneously, and on
the muscles injected, for an efficacious response. Im-
portantly, data show that a 1,500 U dose of aboBoNT-A
can be either injected entirely into the LL, or split
between the UL and LL, as needed by the physician to
enable best treatment of each patients’ unique presenta-
tion of spastic paresis and treatment goals.
The post hoc exploratory nature of this analysis
limits the extrapolation of these data, as the OL ex-
tension phase of the study was not powered for the
statistical comparison of walking speed in patients
who received aboBoNT-A either in the LL or both
the LL and UL simultaneously (11). In addition, this
study enrolled patients who were physically able to
walk 10 m unaided; therefore, the results may not be
generalizable to patients who walk permanently with
orthotics or aids. Despite this, the results presented here
provide an additional insight into the treatment of spas-
tic hemiparesis. Further efficacy data is currently being
prospectively collected from a larger patient group of
adults with hemiparesis after stroke or TBI, following
a 1,500 U dose of aboBoNT-A split between LL and
UL, in the global ENGAGE study (NCT02969356).
ACKNOWLEDGEMENTS
The authors thank all patients involved in the study, as well
as their caregivers, care team, investigators and research staff
in participating institutions. The authors acknowledge Jovita
Balcaitiene, former employee of Ipsen, for contributing to the
conception of the analyses.
Funding. The phase 3 study and post hoc analysis were
funded by Ipsen.
PM served on the speakers’ bureau for Ipsen, Allergan and
Merz, and received grant support from Allergan. SK and SF
816
www.medicaljournals.se/jrm
have no interests to disclose. PP is an employee of Ipsen. RR
is an employee of Ividata subcontracted to Ipsen at the time of
manuscript development. JMG has served as a consultant for and
received research grant support from Allergan, Ipsen and Merz.
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