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Final Program


Final Program

Pain

1340 - The impact of onabotulinumtoxinA on oral pain medication use and low-value care in patients with cervical dystonia

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Objectives: OnabotulinumtoxinA is the only botulinum toxin indicated to treat abnormal head position and neck pain in cervical dystonia. 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.

Design: 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.