Are We Missing Something About the Maximum Dosing of Botulinum Toxin Type A1 in Adult and Pediatric Patients with Spasticity?

IF 3.9 3区医学 Q2 FOOD SCIENCE & TECHNOLOGY Toxins Pub Date : 2024-11-27 DOI:10.3390/toxins16120513

Alessandro Picelli, Rita Di Censo, Stefano Tamburin, Nicola Smania, Mirko Filippetti

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Abstract

Botulinum toxin type A1 is a first-line treatment for adult and pediatric spasticity. However, when considering the quantity of 150 kDa neurotoxin protein in relation to patient weight and the maximum recommended dose for treating adult and pediatric patients with spasticity, several concerns arise. First, the therapeutic margin (the ratio of the actual maximum quantity of toxin recommended for treating adult spasticity to its median lethal dose) appears to be relevant. Second, there is no consistency between adult and pediatric dosing of botulinum toxin type A1 for spasticity. The third point concerns the suitability of the recommended doses for treating spasticity in pediatric patients. Based on the average body weight of American children and adolescents, the maximum weight-based doses for abobotulinumtoxinA and onabotulinumtoxinA could be administered to children as young as 9 years old. Additionally, the maximum weight-based dose for incobotulinumtoxinA could be administered to children as young as 6 years old. The final point concerns managing the maximum dose of BoNT/A1 in pediatric patients with spasticity who weigh more than 25 kg for incobotulinumtoxinA, or more than 34 kg for abobotulinumtoxinA and onabotulinumtoxinA. No labeled recommendations are given on the weight cut-off for transitioning to adult dosing in pediatric patients.

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A1型肉毒杆菌毒素在成人和儿童痉挛患者中的最大剂量是否有所遗漏？

A1型肉毒杆菌毒素是治疗成人和儿童痉挛的一线药物。然而，当考虑到150 kDa神经毒素蛋白与患者体重的关系以及治疗成人和儿童痉挛患者的最大推荐剂量时，出现了一些问题。首先，治疗范围（推荐用于治疗成人痉挛的实际最大毒素量与其中位致死剂量之比）似乎是相关的。其次，A1型肉毒杆菌毒素治疗痉挛的剂量在成人和儿童之间没有一致性。第三点涉及治疗小儿痉挛患者推荐剂量的适宜性。根据美国儿童和青少年的平均体重，以体重为基础的肉毒杆菌毒素a和肉毒杆菌毒素a的最大剂量可用于9岁以下的儿童。此外，以体重为基础的肉毒杆菌毒素a的最大剂量可用于6岁的儿童。最后一点涉及管理BoNT/A1对因肉毒杆菌毒素而体重超过25公斤，或因肉毒杆菌毒素和单肉毒杆菌毒素而体重超过34公斤的痉挛患儿的最大剂量。对于儿科患者过渡到成人剂量的体重临界值，没有给出标签建议。

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来源期刊

Toxins TOXICOLOGY-

CiteScore

7.50

自引率

16.70%

发文量

765

审稿时长

16.24 days

期刊介绍： Toxins (ISSN 2072-6651) is an international, peer-reviewed open access journal which provides an advanced forum for studies related to toxins and toxinology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.