Efficacy and Safety of IncobotulinumtoxinA for Upper- or Combined Upper- and Lower-Limb Spasticity in Children and Adolescents with Cerebral Palsy: Results of the Phase 3 XARA Study.

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Conference Proceeding

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American Journal of Physical Medicine and Rehabilitation


Objectives: The objective of the XARA study was to assess the efficacy and safety of incobotulinumtoxinA for upper- and combined upper- and lower-limb spasticity in ambulant and non-ambulant children and adolescents with cerebral palsy (CP).

Design: XARA (NCT02002884) was a randomized, Phase 3 study with a double-blind main period (MP) and open-label extension (OLEX) period. Patients aged 2–17 years with uni- or bilateral CP and Ashworth Scale (AS) score ≥2 in main clinical target patterns, flexed elbow and/or flexed wrist, were enrolled. In the MP, patients were randomized (2:1:1) to three incobotulinumtoxinA dose groups (8, 6, 2 U/kg body weight [BW]; maximum 200, 150, 50 U/upper limb) with additional lower-limb injections (total body dose ≤16–20 U/kg BW [≤400–500 U], depending on Gross Motor Function Classification System level [GMFCS]). Patients received three further injection cycles (ICs) in the OLEX, with doses per the 8 U/kg BW group. Outcomes included AS, Global Impression of Change Scale (GICS), and adverse events (AEs).

Results: 350 patients (62.9% male, mean [SD] age 7.3 [4.4] years, BW 25.0 [15.0] kg, 30.9% GMFCS IV–V) were treated; 281 (80.3%) completed the study, receiving four incobotulinumtoxinA ICs. In the MP, AS scores for the upper-limb main clinical pattern improved significantly from baseline to Week 4 (p< 0.0001, MMRM), with a significantly greater improvement in the 8 U/kg versus the 2 U/kg dose group (p=0.017, MMRM). Improvements were observed in all treated upper- and lower-limb clinical patterns and across all OLEX ICs. GICS scores confirmed global improvements in upper- and lower-limb spasticity but did not differ between dose groups. There was no increased incidence of AEs with increasing dose or repeated treatment.

Conclusions: In this large pediatric spasticity study, data show the efficacy and safety of incobotulinumtoxinA for muscle tone reduction in multi-level, multi-pattern treatment of spasticity in patients with CP (GMFCS I–V).




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