Botulinum neurotoxin type A in urology: antibodies as a cause of therapy failure.
OBJECTIVE
Botulinum toxin type A (BoNT/A) proved very effective in therapy for hyperactive detrusor or sphincter dysfunction of neurogenic and non-neurogenic origin. However, therapy may fail. In a search for possible reasons, we investigated the presence of BoNT/A antibodies (BoNT/A-AB) in patients who were treated more than once and correlated the presence of antibodies with clinical findings.


METHODS
In 25 patients (aged 11-75 years; average, 48.3 years) who had experienced at least one previous BoNT/A detrusor and/or sphincter injection, BoNT/A-AB was detected with the mouse diaphragm assay before and within 3 months after the current injection. Clinically, subjective and objective outcomes of this injection session were determined on an efficacy scale.


RESULTS
In eight patients, BoNT/A-AB was detected; titers were clearly positive in four patients and were borderline in four patients. The subjective and objective outcomes indicated complete therapy failure in three of four patients who were positive for BoNT/A-AB. In two patients, BoNT/A-AB developed after just one injection session.


CONCLUSIONS
Botulinum toxin type A antibodies can develop after injection of BoNT/A for urologic disorders and the antibodies can lead to therapy failure. In patients with clinically complete therapy failure in whom no obvious other causes can be determined (such as a progressive disease in a patient with multiple sclerosis), screening for BoNT/A-AB should be carried out.
Schulte-Baukloh
Heinrich
H
Department of Urology, St. Hedwig Hospital, Charité Medical School, Humboldt University Berlin, Germany. hschultebaukloh@hotmail.com
Bigalke
Hans
H
Miller
Kurt
K
Heine
Gert
G
Pape
Daniela
D
Lehmann
Jan
J
Knispel
Helmut H
HH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D019274:Botulinum Toxins, Type A / Q000276:immunology* / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000276:immunology; D014549:Urinary Incontinence / Q000188:drug therapy / Q000276:immunology
D000906:Antibodies; D019274:Botulinum Toxins, Type A