{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:20:49Z","timestamp":1792092049302,"version":"4.4.0"},"reference-count":74,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Botulinum toxin A (BTX-A) is commonly employed as a neuromodulator in several neurological diseases and aesthetic indications. Formation of neutralizing antibodies (NAbs) after BTX-A injections may be responsible for treatment failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The authors sought to quantify the prevalence of NAbs following treatment with Abobotulinumtoxin A, Incobotulinumtoxin A, and Onabotulinumtoxin A for therapeutic indications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An electronic systematic search (2000-2020) of PubMed, Scopus, Web of Science, and Embase was conducted. Original studies reporting prevalence of NAbs were included. Data analysis was carried out through open meta-analysis softwares.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty-three studies involving 8833 patients were included in this meta-analysis. The incidence of NAbs was 1.8% (summary estimate = 0.018, 95% CI [0.012, 0.023]); a meta-regression analysis revealed that BTX-A duration was significantly associated with increased incidence of NAbs (P\u2005=\u20050.007). Patients with dystonia had the highest incidence (7.4%) of NAbs against BTX-A (summary estimate = 0.074, 95% CI\u2005=\u2005[0.045, 0.103], I2\u2005=\u200593.%, P\u2005&amp;lt;\u20050.00) followed by patients with spasticity (6.7%) and urological indications (6.2%). Abobotulinumtoxin A was associated with the highest incidence of NAbs (7.4%) (summary estimate = 0.074, 95% CI\u2005=\u2005[0.053, 0.096], I2\u2005=\u200597.24%, P\u2005&amp;lt;\u20050.00) by the Incobotulinumtoxin A and Onabotulinumtoxin A 0.3% (summary estimate &amp;lt;0.003%, 95% CI\u2005=\u2005[\u22120.001, 0.007], P\u2005&amp;lt;\u20050.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the overall incidence of NAbs following BTX-A injections is relatively low, patients with secondary nonresponse to BTX-A with no apparent causes should be investigated for NAbs. A consensus needs to be developed for the optimal management of such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence: 2<\/jats:title><jats:p\/><\/jats:sec>","DOI":"10.1093\/asj\/sjab058","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T01:57:53Z","timestamp":1612403873000},"page":"106-120","source":"Crossref","is-referenced-by-count":35,"title":["Immunogenicity to Botulinum Toxin Type A: A Systematic Review With Meta-Analysis Across Therapeutic Indications"],"prefix":"10.1093","volume":"42","author":[{"given":"Eqram","family":"Rahman","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Royal Free Hospital, University College London , London, Hampstead , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitmi Khalifa","family":"Alhitmi","sequence":"additional","affiliation":[{"name":"Qatar University , Doha , Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Mosahebi","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Royal Free Hospital, University College London , London, Hampstead , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"issue":"4","key":"2022112401254230100_CIT0001","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00702-007-0728-2","article-title":"From poison to remedy: the chequered history of botulinum toxin","volume":"115","author":"Erbguth","year":"2008","journal-title":"J Neural Transm (Vienna)"},{"issue":"10","key":"2022112401254230100_CIT0002","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1002\/mds.22157","article-title":"Long-term treatment with botulinum toxin type A in cervical dystonia has low immunogenicity by mouse protection assay","volume":"23","author":"Brin","year":"2008","journal-title":"Mov Disord"},{"issue":"Suppl 8","key":"2022112401254230100_CIT0003","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1002\/mds.20022","article-title":"Clinical presentation and management of antibody-induced failure of botulinum toxin therapy","volume":"19","author":"Dressler","year":"2004","journal-title":"Mov Disord"},{"issue":"6","key":"2022112401254230100_CIT0004","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s00415-016-8136-x","article-title":"Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes","volume":"263","author":"Jinnah","year":"2016","journal-title":"J Neurol"},{"issue":"1","key":"2022112401254230100_CIT0005","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1080\/08820139.2017.1368544","article-title":"The regions on the light chain of botulinum neurotoxin type A recognized by T cells from toxin-treated cervical dystonia patients. 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