Adverse drug reactions of botulinum neurotoxin type A in children with cerebral palsy: a pharmaco-epidemiological study in VigiBase

Dev Med Child Neurol. 2017 Mar;59(3):329-334. doi: 10.1111/dmcn.13286. Epub 2016 Sep 28.

Abstract

Aim: The aim of this study was to assess the risk of adverse drug reactions (ADRs) with botulinum neurotoxin type A (BoNT-A) in children with cerebral palsy (CP) using the World Health Organization global individual case safety report (ICSR) database, VigiBase.

Method: We extracted all children ICSRs for ADRs with BoNT-A used as anti-spastic drug in CP recorded between 1995 and 2015 in VigiBase. We also performed a case/non-case method (disproportionality analysis) to assess the link between exposure to BoNT-A and each ADR of interest in children and adults, calculating reporting odds ratios (RORs).

Results: In VigiBase, 162 ICSRs were registered. They involved mainly males (n=95, 59%) and mean (SD) age was 7 years 11 months (4y 4mo). The most frequent ADR was dysphagia (27 ICSRs, 17%) followed by asthenia and muscular weakness (25 ICSRs each, 16%). Nineteen ICSRs (12%) were lethal. There was a significant association between BoNT-A and death in children (ROR=11.1 95%, confidence interval [CI] 7.0-17.7) but not in adults.

Interpretation: In children with CP, most ADRs seem to be linked to a systemic spread of BoNT-A. Our study suggests a higher risk of ADRs with BoNT-A in children than in adults.

MeSH terms

  • Adolescent
  • Botulinum Toxins, Type A / therapeutic use*
  • Cerebral Palsy / drug therapy*
  • Cerebral Palsy / epidemiology*
  • Child
  • Child, Preschool
  • Databases, Factual
  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Epidemiologic Studies
  • Female
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Neuromuscular Agents / therapeutic use*
  • Retrospective Studies

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A