Identifying Different Immunoresistance Risk Profiles Among Experienced Aesthetic Botulinum Neurotoxin A Recipients: A Latent Class Analysis

Abstract

Background: Immunoresistance to botulinum neurotoxin A (BoNT-A) due to neutralizing antibodies (NAbs) can lead to partial or complete secondary nonresponse (SNR), potentially limiting individuals' aesthetic and/or medical therapeutic options in the short and/or long term. Understanding factors directly or indirectly influencing BoNT-A immunoresistance risk is crucial. Aims: This analysis explored patterns of latent risk factors (biological and behavioral) that may influence the risk of developing BoNT-A immunoresistance among experienced aesthetic BoNT-A recipients. Methods: Latent class analysis (LCA) was applied to survey data from 363 experienced BoNT-A recipients from six Asia-Pacific countries to identify distinct subgroups based on their patterns of risk factor or risk proxy variables. The five risk proxy variables used for modeling capture information on BoNT-A treatments (treatment indications/locations as proxies for dose), symptoms of declining efficacy, number of aesthetic treatments over the past 3 years, and clinic and BoNT-A formulation switching behaviors. These represent established risk factors and treatment-seeking behaviors suggested to influence immunoresistance risk. Results: LCA identified 3 distinct profiles of individuals, which we described based on the observed patterns of risk proxies as: “lower-risk” (55%), “moderate-risk” (39%), and “higher-risk” (6%). Individuals in the “higher-risk” profile reported higher BoNT-A exposure, more symptoms of declining efficacy, and distinct patterns of knowledge and attitudes toward BoNT-A immunoresistance that could account for their treatment-seeking behaviors. Conclusions: This study suggests that individual behaviors (the “human factor”) have a notable influence on BoNT-A immunoresistance risk. Gaining deeper insights into these factors could support more targeted and effective interventions to mitigate risk.