Safety and efficacy of botulinum toxin type B for treatment of sialorrhea in Parkinson's disease: a prospective double-blind trial.

Abstract

Sialorrhea (drooling) is a common symptom of Parkinson's disease (PD) that can significantly impair a patient's health and quality of life. Fifty-four PD subjects with troublesome sialorrhea were enrolled using a multicenter, randomized, double-blind, sequential-dose escalation design in which subjects received a single intraglandular treatment with botulinum toxin type B (doses of 1,500 Units [0.3 mL]; 2,500 Units [0.5 ml]; or 3,500 Units [0.7 ml]) or placebo. Postinjection, subjects were followed acutely for 4 weeks and long-term for up to 20 weeks. Safety/tolerability, as assessed by adverse events, was the primary outcome measure. Efficacy, as assessed by the Drooling Frequency and Severity Scale and unstimulated salivary flow rate, was secondary. Gastrointestinal-related adverse events occurred more frequently in the active groups versus placebo group (31% vs 7%), with dry mouth being most common (15%). There were no serious adverse events attributed to botulinum toxin type B or discontinuations due to adverse events from treatment. At 4 weeks postinjection, Drooling Frequency and Severity Scale scores significantly improved versus placebo (-1.3 ± 1.3) in a dose-related manner (-2.1 ± 1.2, P = 0.0191; -3.3 ± 1.4, P < 0.0001; -3.5 ± 1.1, P < 0.0001, respectively) and unstimulated salivary flow rates significantly decreased in all active groups versus placebo (P ≤ 0.0009). Furthermore, treated subjects appeared to have more sustained improvement in sialorrhea than placebo subjects. We conclude that intraglandular injection of botulinum toxin type B was safe, tolerable, and efficacious in treating sialorrhea in PD patients. Additional studies are warranted to further confirm the drug's robust efficacy, as well as evaluate its effect with repeated dosing.

• Authors: Robert Chinnapongse, Kristen Gullo, Paul Nemeth, Yuxin Zhang, Lynn Griggs
• Journal: Movement disorders : official journal of the Movement Disorder Society (Mov Disord) Vol. 27 Issue 2 Pg. 219-26 (Feb 2012) ISSN: 1531-8257 [Electronic] United States
• PMID: 21887710 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Movement Disorder Society.

Chemical References

• Anti-Dyskinesia Agents
• rimabotulinumtoxinB
• Botulinum Toxins
• Botulinum Toxins, Type A

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Dyskinesia Agents (therapeutic use)
• Botulinum Toxins (therapeutic use)
• Botulinum Toxins, Type A
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Humans
• Male
• Middle Aged
• Parkinson Disease (complications, drug therapy)
• Prospective Studies
• Severity of Illness Index
• Sialorrhea (drug therapy, etiology)
• Time Factors
• Treatment Outcome
• United States
• Young Adult