Merz Pharmaceuticals announced Xeomin®, the first botulinum toxin type A free from complexing proteins has been granted an extension of indication for post-stroke spasticity of the upper limb presenting with flexed wrist and clenched fist in adults in various European countries. Xeomin® was already granted approval for post-stroke spasticity of the upper limb in early 2009 in Canada, Mexico and Argentina. This important extension of indication is based on the Kanovsky study, the largest randomized, placebo-controlled, double-blind trial with a botulinum toxin in upper limb post-stroke spasticity to date.

Data results published last month in Clinical Neuropharmacology, revealed that Merz Pharmaceuticals' NT 201 (botulinum toxin type A free from complexing proteins), also known by the brand name Xeomin® in Europe and Canada, was statistically significantly more efficacious than placebo for the treatment of patients with post-stroke upper limb spasticity. The Phase III study assessed the impact of NT 201 on muscle tone, functional disability and caregiver burden in patients with post-stroke upper limb spasticity, utilizing a randomized, placebo-controlled, double-blind design.

NT 201 is high in biologic activity and has a low protein load. It has been approved for marketing in Europe since 2005 to treat various movement disorders, and recently approved in Canada for the management of blepharospasm, cervical dystonia of a predominantly rotational form and post-stroke spasticity of the upper limb.

In the Phase III trial, a higher proportion of patients receiving NT 201 were responders in terms of improvement in the wrist flexors four weeks after treatment. Responders were defined as patients with at least 1 point of improvement in the Ashworth Scale Score.

Dr. Alexander Gebauer, Chief Scientific Officer, Head of Global R&D, Merz Pharmaceuticals, Frankfurt, Germany, said, "In addition to the impact it has on the day-to-day life activities, post-stroke spasticity can cause significant pain and discomfort to patients. The positive outcomes presented in this study suggest NT 201 may give promise to patients in search of a treatment option for post-stroke spasticity."

According to the National Stroke Association, 58 percent of stroke survivors experience post-stroke spasticity and only 51 percent of those are receiving treatment for that condition. Aside from pain and significant discomfort, post-stroke muscle spasticity can negatively impact mobility, ability to carry out personal hygiene, and other activities of daily living. In this study, significant improvements were shown in each of the four domains of the Disability Assessment Scale (DAS), including dressing, limb position, hygiene and pain, among patients treated with NT 201.

About Phase III Study

The Phase III study, conducted at 23 sites in Europe, included patients who, at least 6 months prior to enrollment, had experienced a stroke resulting in focal spasticity of the wrist and finger flexors (scores of greater than or equal to 2 on the Ashworth Scale). Participants were required also to have DAS scores of 2 or higher (at least moderate disability) in their chosen therapeutic target domain: dressing, limb position, hygiene or pain.

Medications to treat spasticity such as centrally-acting muscle relaxants and/or benzodiazepines and physical and occupational therapy regimens were permitted if they had been stable in the 2 weeks before screening, but no treatment changes were allowed during the study.

While treatment of the wrist and finger muscles was mandatory, other spastic upper limb muscle groups were treated as individually needed according to the investigator's clinical judgment. The maximum intended dose of study medication was 400 U. Follow-up was for up to 20 weeks.

In an intention-to-treat analysis among a total of 148 patients (NT 201=73; placebo=75), a larger proportion of NT 201 patients (mean 63.9%) were rated as responsive in each of five treatment muscle groups at week 4 as compared with patients receiving placebo (mean 35.72%). For the primary endpoint of wrist flexor treatment, the odds ratio (OR) of 3.97 favored NT 201 treatment significantly (95% confidence interval, 1.9-8.3; P

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