1331 - Patient characteristics and real-world use of botulinum toxins for treatment of chronic sialorrhea

Objectives: Patients with neurological impairment may experience chronic sialorrhea, characterized by excessive drooling, which negatively impacts health and quality of life. We aimed to describe the demographics, clinical characteristics, and treatment patterns among patients with evidence of chronic sialorrhea.

Design: Patients aged ≥2 years with evidence of chronic sialorrhea were identified between 7/1/2007 and 5/21/2022 in Optum's de-identified Clinformatics® Data Mart administrative claims database. Patients were required to have an incident diagnosis of disturbances of salivary secretion (ICD-9-CM: 527.7; ICD-10-CM: K11.7) and evidence of sialorrhea treatment (anticholinergics, botulinum toxins, or surgical excision) within the 30 days on or after diagnosis. We describe patient demographics, comorbidities, and treatment patterns prior to and after diagnosis. No statistical comparisons were conducted.

Results: The final study population included 4,073 chronic sialorrhea patients. The majority of patients were 65+ years old (54%), male (55%), and non-Hispanic white (67%). The most common comorbidities at baseline were Parkinson’s disease (17%) and stroke (11%), reflecting common etiologies for sialorrhea. Anxiety (34%), depression (33%), and dysphagia (54%) were common following diagnosis. First-line oral anticholinergic therapy was more common than botulinum toxin use (69% vs. 34%) after diagnosis of sialorrhea. Less than 1% of patients had surgical excision. The median time until any treatment following diagnosis was 3 days [IQR: 0.5, 16]. Concurrent use of anticholinergic and botulinum toxin therapy was relatively infrequent (6%).

Conclusions: This claims-based study provides insight into the characteristics of insured patients with chronic sialorrhea treated with anticholinergics, toxins, or surgical excision. Patients are commonly non-Hispanic White male patients ≥65 years of age. Off-label use of oral anticholinergics was more common than FDA-approved botulinum toxins therapy following diagnosis. The prevalence of comorbidities post-diagnosis suggests that there is a high burden of disease associated with sialorrhea.