Dysport ® as an Adjunctive Treatment to Bracing in the Management of Adolescent Idiopathic Scoliosis

Johns Hopkins University

Status and phase: Enrolling; Phase 4

Conditions: Adolescent Idiopathic Scoliosis

Treatments: Drug: AbobotulinumtoxinA; Drug: Placebos; Device: Custom Thoracolumbosacral Orthosis

Study type: Interventional

Funder types: Other

Identifiers

NCT03935295

IRB00110399

Details and patient eligibility

About

This study evaluates the combined effect of botulinum toxin A (administered as Dysport® (Ipsen Pharmaceuticals)) and bracing in children with adolescent idiopathic scoliosis. Two thirds of patients will be treated with Dysport® and bracing, while the remaining patients will be treated with placebo and bracing.

Full description

Adolescent idiopathic scoliosis (AIS) is lateral curvature of the spine with an unknown cause in children 10-16 years old. Without treatment, skeletally immature children with idiopathic curves of 20°-40° risk curve progression. Treatment of these patients is focused on either observation or bracing. Although bracing has been shown to be more effective than observation, success is contingent on patient adherence and has the potential for further optimization with adjunct therapies.

Little research is available concerning adjunct therapies that may be used during bracing of AIS patients. One therapy in particular, abobotulinumtoxinA (BTX) injection, has been poorly studied. Injection of BTX into the paraspinal musculature of the concave aspect of the major curve may result in a more malleable curve and thus optimize brace treatment. If BTX injections are found to improve outcomes in this way, a new standard of nonoperative care could be established for AIS patients, potentially reducing the number of patients who undergo surgery.

The aim of this study is to assess whether BTX injections (administered as Dysport® (Ipsen Pharmaceuticals)) in the paraspinal musculature at the site of the major scoliotic curve decrease curve progression in skeletally immature AIS patients who are concurrently treated with bracing. Dysport® will be evaluated primarily as an adjunct treatment to bracing.

Hypotheses

1. Dysport® injections into the concave-side paraspinal muscles will decrease the rate of curve progression, with a lower rate of curve progression in patients treated with both Dysport® injections and bracing compared with those treated with only bracing.
2. Quantitative physical and mental health scores will improve to a greater extent in patients treated with Dysport® and bracing compared with patients treated with only bracing.

Enrollment: 90 estimated patients

Sex: All

Ages: 10 to 16 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Clinically determined idiopathic nature of scoliosis
• Age 10-16 years
• Risser stage 0,1,or 2
• major curve of 20°-40°
• curve apex caudal to T7 vertebra
• ability to adhere to bracing protocol
• Botulinum toxin naïve or previously treated greater than 6 months prior to study entry

Exclusion criteria

• Diagnosis of congenital scoliosis, neuromuscular scoliosis, or other "reason" for scoliosis - Previous surgery at any segment of the spine
• Current need for surgery at any level of the spine
• Treatment with any drug known to interfere with neuromuscular function
• Any other medical condition, laboratory or diagnostic procedure finding that might preclude administration of BTX
• Ongoing infection at the injection sites
• Diagnosis as either resistant or sensitive to botulinum toxin treatment of any type or to any components of the BTX formulation
• Cow milk protein allergy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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90 participants in 2 patient groups, including a placebo group

Botulinum Toxin

Experimental group

Description:

The investigators plan to administer approximately 1000 U Dysport ® in the concave-sided paraspinal musculature of the major curve, based on an estimated total dose of 1000 U, the maximum allowable dose. The total dose per treatment session will not exceed 15 units/kilogram or 1000 units, whichever is lower. If two curves are equivalent within 3˚, both will be treated, however, the dosing (described above) will be divided equally across both curves. There will be two cycles of injections. Patients will be treated at time 0 (baseline) and 4 months.

Treatment:

Device: Custom Thoracolumbosacral Orthosis

Drug: AbobotulinumtoxinA

Placebo

Placebo Comparator group

Description:

Control patients will receive an injection of placebo specifically prepared as a control for this study. The same volumes as indicated in the "experimental" arm description will be injected. These will be administered during two cycles of injections. Patients will be treated at time 0 (baseline) and 4 months.

Treatment:

Device: Custom Thoracolumbosacral Orthosis

Drug: Placebos