Abstract
Botulinum toxins are frequently used in esthetics to improve the appearance of facial wrinkles. In this setting, precise localization of the neurotoxin is required to produce the desired clinical effects. Unwanted effects can occur if the neurotoxin diffuses into untargeted muscle. Therefore, a neurotoxin with low and predictable spread would be preferable for esthetic applications. The aim of this study was to investigate the spread of three approved botulinum toxin type A preparations, with and without complexing proteins, by measuring and comparing the size of the anhidrotic halos they produced following injection of equivalent doses in an identical volume into the forehead of patients. The results showed that incobotulinumtoxinA and onabotulinumtoxinA displayed comparable spread at 6 weeks (maximal area of anhidrosis within 6 weeks) and area under the effect curve (AUEC) over 6 months. However, abobotulinumtoxinA, when assuming a 1:2.5 injection volume ratio, produced a statistically significantly greater maximal area of anhidrosis within 6 weeks and AUEC over 6 months compared with incobotulinumtoxinA. All preparations were well tolerated. The results of this study demonstrate that incobotulinumtoxinA and onabotulinumtoxinA have comparable spread, while abobotulinumtoxinA has significantly greater spread than incobotulinumtoxinA.
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Ascher B, Zakine B, Kestemont P, Baspeyras M, Bougara A, Santini J (2004) A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A in the treatment of glabellar lines. J Am Acad Dermatol 51:223–233
Ascher B, Rzany BJ, Grover R (2009) Efficacy and safety of botulinum toxin type A in the treatment of lateral crow’s feet: double-blind, placebo-controlled, dose-ranging study. Dermatol Surg 35:1478–1486
Benecke R, Jost W, Kanovsky P, Ruzicka E, Comes G, Grafe S (2005) A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia. Neurology 64:1949–1951
Carruthers A, Kiene K, Carruthers J (1996) Botulinum A exotoxin use in clinical dermatology. J Am Acad Dermatol 34:788–797
Carruthers A, Carruthers J (2008) Botulinum toxin products overview. Skin Ther Lett 13:1–5
Carruthers JA, Lowe NJ, Menter MA, Gibson J, Nordquist M, Mordaunt J, Walker P, Eadie N (2002) A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol 46:840–849
Cliff SH, Judodihardjo H, Eltringham E (2008) Different formulations of botulinum toxin type A have different migration characteristics: a double-blind, randomized study. J Cosmet Dermatol 7:50–54
de Almeida AT, De Boulle KJ (2007) Diffusion characteristics of botulinum neurotoxin products and their clinical significance in cosmetic applications. J Cosmet Laser Ther 9(Suppl 1):17–22
De Boulle K, Fragien S, Sommer B, Glogau R (2010) Treating glabellar lines with botulinum toxin type-A-hemagglutinin complex: a review of the science, the clinical data, and patient satisfaction. Clin Interv Aging 5:101–118
De Maio M, Rzany B (2007) Botulinum toxin in aesthetic medicine. Springer, Heidelberg, Germany
Dressler D, Benecke R (2007) Pharmacology of therapeutic botulinum toxin preparations. Disabil Rehabil 29:1761–1768
Eisele KH, Fink K, Vey M, Taylor HV (2011) Studies on the dissociation of botulinum neurotoxin type A complexes. Toxicon 57:555–565
Hexsel D, Dal’Forno T, Hexsel C, Do Prado DZ, Lima MM (2008) A randomized pilot study comparing the action halos of two commercial preparations of botulinum toxin type A. Dermatol Sur 34:52–59
Hsu TS, Dover JS, Arndt KA (2004) Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol 140:1351–1354
Inoue K, Fujinaga Y, Watanabe T, Ohyama T, Takeshi K, Moriishi K, Nakajima H, Inoue K, Oguma K (1996) Molecular composition of Clostridium botulinum type A progenitor toxins. Infect Immun 64:1589–1594
Jost WH, Kohl A, Brinkmann S, Comes G (2005) Efficacy and tolerability of a botulinum toxin type A free of complexing proteins (NT 201) compared with commercially available botulinum toxin type A (Botox®) in healthy volunteers. J Neural Transm 112:905–913
Kanovský P, Slawek J, Denes Z, Platz T, Sassin I, Comes G, Grafe S (2009) Efficacy and safety of botulinum neurotoxin NT 201 in poststroke upper limb spasticity. Clin Neuropharmacol 32:259–265
Karsai S, Raulin C (2009) Current evidence on the unit equivalence of different botulinum neurotoxin A formulations and recommendations for clinical practice in dermatology. Dermatol Surg 35:1–8
Klein A, Carruthers A, Fagien S, Lowe NJ (2008) Comparisons among botulinum toxins: an evidence-based review. Plast Reconstr Surg 121:413e–422e
Lowe NJ, Ascher B, Heckmann M, Kumar C, Fraczek S, Eadie N (2005) Double-blind, randomised, placebo-controlled, dose-response study of the safety and efficacy of botulinum toxin type A in subjects with crow’s feet. Dermatol Surg 31:257–262
Minor V (1928) Ein neues verfahren zu der klinischen untersuchung der schweiβabsonderung. Deutsch Z Nervenhlk 101:302–308
Monheit G, Carruthers A, Brandt F, Rand R (2007) A randomised, double-blind, placebo-controlled study of botulinum toxin type A for the treatment of glabellar lines: determination of optimal dose. Dermatol Surg 33:S51–S59
Roggenkämper P, Jost W, Bihari K, Comes G, Grafe S (2006) Efficacy and safety of a new botulinum toxin type A free of complexing proteins in the treatment of blepharospasm. J Neural Transm 113:303–312
Trindade de Almeida AR, Marques E, de Almeida J, Cunha T, Boraso R (2007) Pilot study comparing the diffusion of two formulations of botulinum toxin type A in patients with forehead hyperhidrosis. Dermatol Surg 33:S37–S43
Wohlfarth K, Muller C, Sassin I, Comes G, Grafe S (2007) Neurophysiological double-blind trial of a botulinum neurotoxin type A free of complexing proteins. Clin Neuropharmacol 30:86–94
Acknowledgments
The authors wish to thank Ulrike Beimel and Luciano Zoppelli. The study was sponsored by Merz Pharmaceuticals GmbH. Editorial assistance was provided by Ogilvy 4D and funding was provided by Merz Pharmaceuticals GmbH.
Conflict of interest
University of Hamburg, Division of Cosmetic Sciences (Head: Professor Martina Kerscher) collaborates with Merz Pharmaceuticals GmbH, Q-Med AB, Laboratoires Pierre Fabre SA and Kythera on several clinical studies. Dr Walter Wigger-Alberti has no financial relationship with Merz Pharmaceuticals GmbH and declares that he has no conflict of interest. Drs S Roll and A Becker are employees of Merz Pharmaceuticals GmbH, Germany.
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Kerscher, M., Roll, S., Becker, A. et al. Comparison of the spread of three botulinum toxin type A preparations. Arch Dermatol Res 304, 155–161 (2012). https://doi.org/10.1007/s00403-011-1179-z
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DOI: https://doi.org/10.1007/s00403-011-1179-z