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Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study. Toxins (Basel) 2021; 13:toxins13060374. [PMID: 34073918 PMCID: PMC8225105 DOI: 10.3390/toxins13060374] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022] Open
Abstract
Early management of spasticity may improve stroke outcome. Botulinum toxin type A (BoNT-A) is recommended treatment for post-stroke spasticity (PSS). However, it is usually administered in the chronic phase of stroke. Our aim was to determine whether the length of time between stroke onset and initial BoNT-A injection has an effect on outcomes after PSS treatment. This multicenter, longitudinal, cohort study included stroke patients (time since onset <12 months) with PSS who received BoNT-A for the first time according to routine practice. The main outcome was the modified Ashworth scale (MAS). Patients were evaluated before BoNT-A injection and then at 4, 12, and 24 weeks of follow-up. Eighty-three patients with PSS were enrolled. MAS showed a significant decrease in PSS at 4 and 12 weeks but not at 24 weeks after treatment. Among the patients with a time between stroke onset and BoNT-A injection >90 days, the MAS were higher at 4 and 12 weeks than at 24 weeks compared to those injected ≤90 days since stroke. Our findings suggest that BoNT-A treatment for PSS should be initiated within 3 months after stroke onset in order to obtain a greater reduction in muscle tone at 1 and 3 months afterwards.
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Palazón-García R, Benavente-Valdepeñas AM. Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury. Int J Mol Sci 2021; 22:ijms22094886. [PMID: 34063051 PMCID: PMC8125452 DOI: 10.3390/ijms22094886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.
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Affiliation(s)
- Ramiro Palazón-García
- Physical Medicine and Rehabilitation Department, Hospital Nacional de Parapléjicos, 45004 Toledo, Spain
- Correspondence:
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Delgado MR, Tilton A, Carranza‐Del Río J, Dursun N, Bonikowski M, Aydin R, Maciag‐Tymecka I, Oleszek J, Dabrowski E, Grandoulier A, Picaut P. Efficacy and safety of abobotulinumtoxinA for upper limb spasticity in children with cerebral palsy: a randomized repeat-treatment study. Dev Med Child Neurol 2021; 63:592-600. [PMID: 33206382 PMCID: PMC8048784 DOI: 10.1111/dmcn.14733] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess the efficacy and safety of repeat abobotulinumtoxinA injections in reducing upper limb spasticity in children with cerebral palsy (CP). METHOD This was a double-blind, repeat-cycle study (NCT02106351) in children with CP (2-17y). Children were randomized to receive 2U/kg (control), 8U/kg, or 16U/kg abobotulinumtoxinA injections into the target muscle group (wrist or elbow flexors) and additional muscles alongside occupational therapy via a home-exercise therapy program (HETP; minimum five 15min sessions/wk). Children received 8U/kg or 16U/kg plus HETP in cycles 2 to 4. RESULTS During cycle 1, 210 children (126 males, 84 females; mean age [SD] 9y [4y 5mo], range 2-17y; n=70/group) had at least one upper limb abobotulinumtoxinA injection and 209 complied with the HETP. At week 6 of cycle 1, children in the 8U/kg or 16U/kg groups had significantly lower Modified Ashworth scale scores versus the 2U/kg group (primary outcome: treatment differences of -0.4 [p=0.012] and -0.7 [p<0.001] respectively). All groups improved on Physician Global Assessment and children in all groups achieved their treatment goals at least as expected. Therapeutic benefits were sustained during cycles 2 to 4; muscular weakness was the only treatment-related adverse event reported in at least one child/group (4.3% and 5.7% vs 1.4% respectively). INTERPRETATION Treatment with 8U/kg or 16U/kg abobotulinumtoxinA significantly reduced upper limb spasticity versus the 2U/kg control dose. Therapeutic benefits of abobotulinumtoxinA plus HETP were sustained with repeat treatment cycles. WHAT THIS PAPER ADDS AbobotulinumtoxinA injections significantly reduced upper limb spasticity in children with cerebral palsy. Children treated with abobotulinumtoxinA and targeted home exercises showed global improvement and goal attainment. Benefits were sustained over 1 year with repeat cycles of abobotulinumtoxinA and home exercises. AbobotulinumtoxinA injections into the upper limb were well tolerated over 1 year.
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Affiliation(s)
- Mauricio R Delgado
- Department of NeurologyUniversity of Texas Southwestern Medical CenterScottish Rite Hospital for ChildrenDallasTXUSA
| | - Ann Tilton
- Department of NeurologyLSUHSC and Children's Hospital New OrleansNew OrleansLAUSA
| | | | - Nigar Dursun
- Department of Physical Medicine and RehabilitationFaculty of MedicineKocaeli UniversityKocaeliTurkey
| | | | - Resa Aydin
- Department of Physical Medicine and RehabilitationIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | | | - Joyce Oleszek
- Department of Physical Medicine and RehabilitationUniversity of Colorado and Children's Hospital ColoradoAuroraCOUSA
| | - Edward Dabrowski
- Department of Pediatric Physical Medicine and RehabilitationBeaumont HealthOakland University School of MedicineGrosse PointeMIUSA
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Schlessinger J, Cohen JL, Shamban A, Jacob C, Karimi K, Maas C, Lane V, Coquis-Knezek S, Meckfessel M. A Multicenter Study to Evaluate Subject Satisfaction With Two Treatments of AbobotulinumtoxinA a Year in the Glabellar Lines. Dermatol Surg 2021; 47:504-509. [PMID: 33165057 PMCID: PMC8021233 DOI: 10.1097/dss.0000000000002846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Real-world re-treatment intervals for botulinum toxins vary, but most subjects receive treatment less frequently than the manufacturer-recommended minimum intervals. In subjects receiving treatment with AbobotulinumtoxinA (ABO) less frequently, high levels of satisfaction and psychosocial improvements in well-being, self-confidence, and quality of life are observed. OBJECTIVE To evaluate subject satisfaction with a twice yearly re-treatment schedule. METHODS AND MATERIALS This open-label, multicenter, interventional study evaluated subject satisfaction following injections of ABO 50 U in the glabellar lines at baseline and 6 months. The primary end point was subject satisfaction at 12 months. Secondary endpoints included subject satisfaction, FACE-Q scales, and glabellar line severity scale (GLSS). RESULTS Ninety-five percent of the 120 subjects were "highly satisfied" or "satisfied" with their treatment outcomes at 12 months. FACE-Q total scores suggested that subjects were less bothered by glabellar lines and felt better about their facial appearance with each treatment versus baseline. Approximately half of subjects had ≥1-grade improvement from baseline in GLSS at 12 months. Median onset of effect was 2 days. CONCLUSION The majority of subjects (95%) were satisfied with ABO treatment every 6 months; results were supported by high subject satisfaction, long duration, rapid onset, natural-looking results, and overall psychological wellness and safety.
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Affiliation(s)
| | | | - Ava Shamban
- Advanced Skin Research Center
- University of California Irvine
- Chicago Cosmetic Surgery and Dermatology
- Rejuva Medical Aesthetics, Inc
- University of California San Francisco
- Medsense Ltd
- Galderma Laboratories
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Giannantoni A, Gubbiotti M, Rubilotta E, Balzarro M, Antonelli A, Bini V. IncobotulinumtoxinA versus OnabotulinumtoxinA intradetrusor injections in patients with neurogenic detrusor overactivity incontinence: a double-blind, randomized, non-inferiority trial. Minerva Urol Nephrol 2021; 74:625-635. [PMID: 33769020 DOI: 10.23736/s2724-6051.21.04227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA vs OnabotulinumtoxinA intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization. METHODS Sixty-four patients with Spinal Cord Injury or Multiple Sclerosis were randomized to receive 30 intradetrusor injections of IncobotulinumtoxinA or OnabotulinumtoxinA 200 U; 28 patients in IncobotulinumtoxinA group and 29 in OnabotulinumtoxinA group completed the study. Primary outcome measure was the noninferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Secondary outcomes measures were changes in Incontinence- Quality of Life questionnaire, Visual Analog Scale score (bother of symptoms on Quality of Life), urodynamic parameters, occurrence of adverse effects and related costs (week 12). RESULTS At week 12, mean value of difference in urinary incontinence episodes/day between the two groups was -0.2 (95% two-sided CI: -1; 0.7); the difference in incontinence episodes/day between the two groups was -0.4 with a higher limit of one-sided 95% CI of 0.2 episodes/day which was much lower than the non-inferiority margin of one episode/day. Total score and subscores of Incontinence- Quality of Life questionnaire, Visual Analog Scale Scores and urodynamics did not show differences between the two groups. Adverse effects were similar for both treatments, with urinary tract infection being the most frequent, localised effect. Minor costs were observed following IncobotulinumtoxinA. CONCLUSIONS In patients with refractory neurogenic incontinence due to Spinal Cord Injury or Multiple Sclerosis, IncobotulinumtoxinA was not inferior to OnabotulinumtoxinA in improving clinical and urodynamic findings in the short-term follow-up, with comparable adverse effects but minor costs.
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Affiliation(s)
- Antonella Giannantoni
- Functional and Surgical Urology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | | | | | - Matteo Balzarro
- Department of Urology, University Hospital of Verona, Verona, Italy
| | | | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
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Galadari H, Galadari I, Smit R, Prygova I, Redaelli A. Use of AbobotulinumtoxinA for Cosmetic Treatments in the Neck, and Middle and Lower Areas of the Face: A Systematic Review. Toxins (Basel) 2021; 13:toxins13020169. [PMID: 33671800 PMCID: PMC7926328 DOI: 10.3390/toxins13020169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 02/01/2023] Open
Abstract
AbobotulinumtoxinA (aboBoNT-A) has been used for various cosmetic purposes, including minimization of moderate to severe lines, or other cosmetic indications, in the face and neck. We carried out a systematic review to identify all relevant evidence on the treatment approaches and outcomes of aboBoNT-A as a cosmetic treatment of the middle and lower areas of the face, and the neck. Embase, MEDLINE, Cochrane Library, congress proceedings and review bibliographies were searched for relevant studies. Identified articles were screened against pre-specified eligibility criteria. Of 560 unique articles identified, 10 were included for data extraction (three observational studies, 1 randomized controlled trial [with two articles] and five non-randomized trials). The articles provided data on gummy/asymmetric smile (2), marionette lines (5), masseter muscle volume (2), nasal wrinkles (2), perioral wrinkles (3) and the platysma muscle (4). All articles reporting on efficacy of aboBoNT-A demonstrated positive results, including reduction of wrinkles (5), reduction of masseter muscle (2) and degree of gummy smile (1) compared with before treatment. No serious adverse events were reported and patient satisfaction was high. In conclusion, positive findings support further research of aboBoNT-A for the middle and lower areas of the face, and in the neck, which are largely unapproved indications.
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Affiliation(s)
- Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE;
- Correspondence: ; Tel.: +971-03-7137571
| | - Ibrahim Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE;
| | - Riekie Smit
- Riekie Smit Practice, Pretoria 0182, South Africa;
| | - Inna Prygova
- Ipsen Pharmaceutical, 92100 Boulogne-Billancourt, France;
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Botulinum Toxin Type A to Improve Facial Symmetry in Facial Palsy: A Practical Guideline and Clinical Experience. Toxins (Basel) 2021; 13:toxins13020159. [PMID: 33670477 PMCID: PMC7923088 DOI: 10.3390/toxins13020159] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a "paralyzed" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.
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Smit R, Gubanova E, Kaufman J, Landau M, Molina B, Andriopoulos B, Maisonobe P, Prygova I, Redaelli A. Patient Satisfaction with AbobotulinumtoxinA for Aesthetic Use in the Upper Face: A Systematic Literature Review and Post-hoc Analysis of the APPEAL Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E69-E88. [PMID: 34221231 PMCID: PMC8211347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND: AbobotulinumtoxinA (AboBoNT-A; Dysport®; Ipsen, Boulogne-Billancourt, France/Azzalure®; Galderma, Lausanne, Switzerland) is a botulinum neurotoxin type A approved for aesthetic use in the treatment of glabellar lines in adult patients under 65 years in Europe, the United States, and other countries. OBJECTIVE: We sought to analyze current literature on patient satisfaction with aboBoNT-A for upper facial aesthetic indications. METHODS: A systematic review of literature databases (PubMed/MEDLINE, Embase, the Cochrane Library, and Google Scholar) was performed to identify English-language publications reporting on patients with aesthetic indications (including glabellar lines and wrinkles) receiving aboBoNT-A, that assessed patient and/or physician satisfaction with treatment, with no restrictions on comparator studies. Structured data extraction was used to enable inter-study analysis. A post-hoc analysis was also performed to assess patient satisfaction by sex and age, using results from the noninterventional APPEAL study of patients' satisfaction with aboBoNT-A for treating glabellar lines. RESULTS: Overall, 22 original research papers were identified. Patient satisfaction rates for aboBoNT-A treatment were significantly higher versus placebo from two weeks to between three and five months postinjection. At two to three weeks postinjection, patient satisfaction rates were 52% and 99% across studies. In studies with later time points, patient satisfaction rates were 85 to 87 percent at 5 months and between 25 and 100 percent at 6 months post-injection. Physician satisfaction was also high (97%-100%, across three treatments). No notable differences in patient satisfaction by sex or age were observed in the APPEAL study. CONCLUSION: High rates of patient satisfaction have been achieved with aboBoNT-A treatment for upper facial aesthetic indications. Despite the current recommended interval of ≥12 weeks, satisfaction with the aesthetic results of aboBoNT-A therapy is still evident up to 6 months post-injection in some patients.
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Affiliation(s)
- Riekie Smit
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Elena Gubanova
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Joely Kaufman
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Marina Landau
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Beatriz Molina
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Bill Andriopoulos
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Pascal Maisonobe
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Inna Prygova
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
| | - Alessio Redaelli
- Dr. Smit is with the Dr. Riekie Smit Aesthetic Medical Practice in Pretoria, South Africa
- Dr. Gubanova is with Vallex Med Clinic of Preventive Medicine, Moscow National University of Food Production in Moscow, Russian Federation
- Dr. Kaufman is with the University of Miami, Miller School of Medicine and Skin Associates of South Florida in Coral Gables, Florida, United States of America
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Molina is with Medikas Medispa in Street, Somerset, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden. Mr. Maisonobe and Dr. Prygova are with Ipsen Pharma, Boulogne-Billancourt, France
- Dr. Redaelli is with the Visconti di Modrone Medical Center in Milan, Italy
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Choudhury S, Baker MR, Chatterjee S, Kumar H. Botulinum Toxin: An Update on Pharmacology and Newer Products in Development. Toxins (Basel) 2021; 13:58. [PMID: 33466571 PMCID: PMC7828686 DOI: 10.3390/toxins13010058] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022] Open
Abstract
Since its introduction as a treatment for strabismus, botulinum toxin (BoNT) has had a phenomenal journey and is now recommended as first-line treatment for focal dystonia, despite short-term clinical benefits and the risks of adverse effects. To cater for the high demand across various medical specialties, at least six US Food and Drug Administration (FDA)-approved formulations of BoNT are currently available for diverse labelled indications. The toxo-pharmacological properties of these formulations are not uniform and thus should not be used interchangeably. Synthetic BoNTs and BoNTs from non-clostridial sources are not far from clinical use. Moreover, the study of mutations in naturally occurring toxins has led to modulation in the toxo-pharmacokinetic properties of BoNTs, including the duration and potency. We present an overview of the toxo-pharmacology of conventional and novel BoNT preparations, including those awaiting imminent translation from the laboratory to the clinic.
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Affiliation(s)
- Supriyo Choudhury
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
| | - Mark R. Baker
- Departments of Neurology and Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, UK;
- Translational and Clinical Research Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Suparna Chatterjee
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences Kolkata, Kolkata 700017, India; (S.C.); (S.C.)
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Fabi SG, Cohen JL, Green LJ, Dhawan S, Kontis TC, Baumann L, Gross TM, Gallagher CJ, Brown J, Rubio RG. DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Efficacy Results From SAKURA 3, a Large, Open-Label, Phase 3 Safety Study. Dermatol Surg 2021; 47:48-54. [PMID: 32773446 PMCID: PMC7752211 DOI: 10.1097/dss.0000000000002531] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND DaxibotulinumtoxinA for Injection (DAXI) is botulinum toxin Type A formulated with a novel peptide excipient. Two pivotal, single-treatment, placebo-controlled trials demonstrated efficacy and safety for moderate or severe glabellar lines. OBJECTIVE To further evaluate DAXI in a large, open-label, repeat-treatment study. METHODS Subjects (n = 2,691) were enrolled from the preceding pivotal trials or de novo and received 40U DAXI. Those who received repeat treatments could be retreated when they returned to baseline on the Investigator Global Assessment-Frown Wrinkle Severity (IGA-FWS) and Patient FWS (PFWS) scales at/after 12 weeks and up to 36 weeks after treatment. RESULTS High (>96%) response rates (none or mild severity) on the IGA-FWS scale were seen after each of the 3 treatments, with peak response between Weeks 2 to 4. At Week 24, ≥32% had a response of none or mild severity. Peak response rates of ≥92% were observed at Weeks 2 to 4 on the PFWS scale. The median duration for return to moderate or severe severity was 24 weeks. The safety profile was favorable and consistent with previous trials. CONCLUSION DaxibotulinumtoxinA for Injection efficacy was highly consistent across treatment cycles. These results confirm the previously observed efficacy rates and duration of response.
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Affiliation(s)
- Sabrina G. Fabi
- University of California, San Diego and Cosmetic Laser Dermatology, San Diego, California
| | - Joel L. Cohen
- AboutSkin Dermatology and DermSurgery, PC, Greenwood Village, Colorado
| | - Lawrence J. Green
- George Washington University School of Medicine and Aesthetic and Dermatology Center, Rockville, Maryland
| | - Sunil Dhawan
- Center for Dermatology Cosmetic and Laser Surgery, Fremont, California
| | - Theda C. Kontis
- The Johns Hopkins Hospital and The Aesthetic Center at Woodholme, Baltimore, Maryland
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Abstract
Spasticity is one component of the upper motor neuron (UMN) syndrome resulting from a multitude of neurologic conditions, such as stroke, brain injury, spinal cord injury, multiple sclerosis, and cerebral palsy. It is clinically recognized as a phenomenon of velocity-dependent increase in resistance, i.e., hypertonia. Recent advances in the pathophysiology of spasticity improve our understanding of mechanisms underlying this complex phenomenon and its relations to other components of UMN syndrome (weakness and disordered motor control), as well as the resultant clinical problems. This theoretical framework provides a foundation to set up treatment goals and to guide goal-oriented clinical assessment and treatment. Among a spectrum of treatment options, botulinum toxin (BoNT) therapy is the preferred treatment for focal spasticity. The evidence is very robust that BoNT therapy effectively reduces spasticity; however, it does not improve voluntary movement. In this chapter, we highlight a few issues on how to achieve the best clinical outcomes of BoNT therapy, such as dosing, dilution, guidance techniques, adjunctive therapies, early treatment, repeated injections, and central effects, as well as the ways to improve motor function in selected subgroups of patients with spasticity. We also discuss the reasons of poor responses to BoNT therapy and when not to use BoNT therapy.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA.
- TIRR Memorial Hermann Hospital, Houston, TX, USA.
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA
- TIRR Memorial Hermann Hospital, Houston, TX, USA
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Patel AT, Wein T, Bahroo LB, Wilczynski O, Rios CD, Murie-Fernández M. Perspective of an International Online Patient and Caregiver Community on the Burden of Spasticity and Impact of Botulinum Neurotoxin Therapy: Survey Study. JMIR Public Health Surveill 2020; 6:e17928. [PMID: 33284124 PMCID: PMC7752537 DOI: 10.2196/17928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/05/2020] [Accepted: 10/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Patient- and caregiver-reported data are lacking on the burden of spasticity, and the impact of botulinum neurotoxin type A (BoNT-A) treatment for this condition, on patients' daily lives. As recommended in recent guidance from the US Food and Drug Administration, online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on the burden of conditions experienced by patients and caregivers and their views on treatment options in order to inform evidence-based medicine and drug development. Objective The objective of our study is to characterize spasticity symptoms and their associated burdens on Western European and US patients and caregivers in the realms of work, daily activities, quality of life (QoL), as well as the positive and negative impacts of treatment with BoNT-A (cost, time, QoL) using Carenity, an international online community for people with chronic health conditions. Methods We performed a noninterventional, multinational survey. Eligible participants were 18 years old or older and had, or had cared for, someone with spasticity who had been treated with BoNT-A for at least 1 year. Patients and caregivers were asked to complete an internet-based survey via Carenity; caregivers reported their own answers and answered on behalf of their patients. Questions included the burden of spasticity on the ability to work, functioning, daily-living activities, and QoL, the impact of BoNT A therapy on patients' lives, and the potential benefits of fewer injections. Results There were 615 respondents (427 patients and 188 caregivers). The mean age of patients and caregivers was 41.7 years and 38.6 years, respectively, and the most commonly reported cause of spasticity was multiple sclerosis. Caregivers were most often the parents (76/188, 40%) or another family member (51/188, 27%) of their patients. Spasticity had a clear impact on patients' and caregivers' lives, including the ability to work and injection costs. For patients, spasticity caused difficulties with activities of daily living and reduced QoL indices. The median number of BoNT-A injections was 4 times per year, and 92% (393/427) of patients reported that treatment improved their overall satisfaction with life. Regarding the BoNT-A injection burden, the greatest patient-reported challenges were the cost and availability of timely appointments. Overall, 86% (368/427) of patients believed that a reduced injection frequency would be beneficial. Caregivers answering for their patients gave largely similar responses to those reported by patients. Conclusions Spasticity has a negative impact on both patients' and caregivers' lives. All respondents reported that BoNT A treatment improved their lives, despite the associated challenges. Patients believed that reducing the frequency of BoNT-A injections could alleviate practical issues associated with treatment, implying that a longer-acting BoNT-A injection would be well received.
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Affiliation(s)
- Atul T Patel
- Kansas City Bone & Joint Clinic, Overland Park, KS, United States
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Laxman B Bahroo
- Department of Neurology, Georgetown University, Georgetown, DC, United States
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63
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Nestor M, Cohen JL, Landau M, Hilton S, Nikolis A, Haq S, Viel M, Andriopoulos B, Prygova I, Foster K, Redaelli A, Picaut P. Onset and Duration of AbobotulinumtoxinA for Aesthetic Use in the Upper face: A Systematic Literature Review. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:E56-E83. [PMID: 33488922 PMCID: PMC7819591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE: We sought to analyze the current literature regarding time to onset and duration of effect of abobotulinumtoxinA (aboBoNT-A, Dysport®/Azzalure®) for upper facial aesthetic indications. METHODS: We conducted a systematic review of literature databases (PubMed/MEDLINE, Embase, Cochrane Library, and Google Scholar) to identify English-language publications relevant to: population (patients with aesthetic indications [including glabellar lines and wrinkles]); interventions (aboBoNT-A); comparators (no restrictions); outcomes (efficacy, including onset of action and duration of effect); and settings (clinical). A manual search of review paper bibliographies was performed. Structured data extraction was used to enable interstudy analysis. RESULTS: Overall, 42 original research papers relevant to aboBoNT-A onset and/or duration were identified. All 24 studies assessing efficacy within one week post-injection demonstrated some response at the first time point assessed, and all 37 studies assessing duration showed some response after 12 weeks. Although methodologies for assessing onset and duration differed, when outcomes were refined by reported mean/median, at least 50 percent of patients responding to treatment, or significance versus placebo or baseline at a given time point, onset was most often reported within 2 to 3 days (7 studies), and as early as 24 hours (2 studies). Duration was most often reported as four months (18 studies), although four studies provided evidence that aboBoNT-A efficacy was maintained at five months and three studies at or after six months post-injection. CONCLUSION: This review indicates that aboBoNT-A has a median onset of efficacy of 2 to 3 days and a longer duration of action (3-6 months across studies) than the current labelled minimum treatment interval (12 weeks).
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Affiliation(s)
- Mark Nestor
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Joel L Cohen
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Marina Landau
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Said Hilton
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Andreas Nikolis
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Syed Haq
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Maurizio Viel
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Bill Andriopoulos
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Inna Prygova
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Keith Foster
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Alessio Redaelli
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
| | - Philippe Picaut
- Dr. Nestor is with the Miller School of Medicine at the University of Miami in Miami, Florida, and the Center for Cosmetic Enhancement and Center for Clinical and Cosmetic Research in Aventura, Florida
- Dr. Cohen is with AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado and the University of California, Irvine, in Irvine, California
- Dr. Landau is with Wolfson Medical Center in Holon, Israel
- Dr. Hilton is with Dr. Hilton and Partner in Düsseldorf, Germany
- Dr. Nikolis is with the University of Montreal in Montreal, Québec, Canada
- Dr. Haq is with Invictus Humanus in London, United Kingdom
- Dr. Viel is with London Center for Aesthetic Surgery in London, United Kingdom
- Dr. Andriopoulos is with Galderma Aesthetics in Uppsala, Sweden
- Drs. Prygova, Foster, and Picaut are with Ipsen Pharma in Boulogne-Billancourt, France
- Dr. Redaelli is with Visconti di Modrone Medical Center in Milan, Italy
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Esquenazi A, Delgado MR, Hauser RA, Picaut P, Foster K, Lysandropoulos A, Gracies JM. Duration of Symptom Relief Between Injections for AbobotulinumtoxinA (Dysport®) in Spastic Paresis and Cervical Dystonia: Comparison of Evidence From Clinical Studies. Front Neurol 2020; 11:576117. [PMID: 33101184 PMCID: PMC7546809 DOI: 10.3389/fneur.2020.576117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Botulinum toxin-A is a well-established treatment for adult and pediatric spastic paresis and cervical dystonia. While guidelines and approved labels indicate that treatment should not occur more frequently than every 12 weeks, studies and real-world evidence show that the timing of symptom recurrence between treatments may vary. Methods: We report retreatment criteria and response duration (retreatment intervals) from four pivotal, double-blind, placebo-controlled studies with open-label extensions involving patients treated with abobotulinumtoxinA (aboBoNTA) for upper limb (NCT01313299) or lower limb (NCT01249404) spastic paresis in adults, lower limb spastic paresis in children (NCT01249417), and cervical dystonia in adults (NCT00257660). We review results in light of recently available preclinical data. Results: In spastic paresis, 24.0-36.9% of upper limb patients treated with aboBoNTA and 20.1-32.0% of lower limb patients did not require retreatment before 16 weeks. Moreover, 72.8-93.8% of aboBoNTA-treated pediatric patients with lower limb spastic paresis did not require retreatment before 16 weeks (17.7-54.0% did not require retreatment before 28 weeks). In aboBoNTA-treated patients with cervical dystonia, 72.6-81.5% did not require retreatment before 16 weeks. Conclusion: AboBoNTA, when dosed as recommended, offers symptom relief beyond 12 weeks to many patients with spastic paresis and cervical dystonia. From recently available preclinical research, the amount of active neurotoxin administered with aboBoNTA might be a factor in explaining this long duration of response.
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Affiliation(s)
- Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, United States
| | - Mauricio R Delgado
- Neurology and Neurotherapeutics Department, University of Texas Southwestern Medical Center and Scottish Rite Hospital for Children, Dallas, TX, United States
| | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, United States
| | | | | | | | - Jean-Michel Gracies
- UR 7377, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Albert Chenevier-Henri Mondor Hospital, Créteil, France
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Colosimo C, Charles D, Misra VP, Maisonobe P, Om S. Cumulative effects of long-term treatment with abobotulinumtoxinA in cervical dystonia: Findings from a prospective, observational study. J Neurol Sci 2020; 416:117015. [DOI: 10.1016/j.jns.2020.117015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 11/25/2022]
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66
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Fairmont I, Winkler A. Novel Cosmetic Uses of Botulinum Toxin in the Head and Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Luvisetto S. Botulinum Toxin and Neuronal Regeneration after Traumatic Injury of Central and Peripheral Nervous System. Toxins (Basel) 2020; 12:E434. [PMID: 32630737 PMCID: PMC7404966 DOI: 10.3390/toxins12070434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are toxins produced by the bacteria Clostridiumbotulinum, the causing agent for botulism, in different serotypes, seven of which (A-G) are well characterized, while others, such as H or FA, are still debated. BoNTs exert their action by blocking SNARE (soluble N-ethylmale-imide-sensitive factor-attachment protein receptors) complex formation and vesicle release from the neuronal terminal through the specific cleavage of SNARE proteins. The action of BoNTs at the neuromuscular junction has been extensively investigated and knowledge gained in this field has set the foundation for the use of these toxins in a variety of human pathologies characterized by excessive muscle contractions. In parallel, BoNTs became a cosmetic drug due to its power to ward off facial wrinkles following the activity of the mimic muscles. Successively, BoNTs became therapeutic agents that have proven to be successful in the treatment of different neurological disorders, with new indications emerging or being approved each year. In particular, BoNT/A became the treatment of excellence not only for muscle hyperactivity conditions, such as dystonia and spasticity, but also to reduce pain in a series of painful states, such as neuropathic pain, lumbar and myofascial pain, and to treat various dysfunctions of the urinary bladder. This review summarizes recent experimental findings on the potential efficacy of BoNTs in favoring nerve regeneration after traumatic injury in the peripheral nervous system, such as the injury of peripheral nerves, like sciatic nerve, and in the central nervous system, such as spinal cord injury.
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Affiliation(s)
- Siro Luvisetto
- Institute of Biochemistry and Cell Biology, National Research Council of Italy, via Ramarini 32, Monterotondo Scalo, 00015 Rome, Italy
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68
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Cornet S, Périer C, Wagner S, Andriambeloson E, Pouzet B, Kalinichev M. The use of the dynamic weight bearing test to assess the effects of acute, intramuscularly administered botulinum neurotoxin type A1 in rats. Toxicon X 2020; 7:100041. [PMID: 32550595 PMCID: PMC7286111 DOI: 10.1016/j.toxcx.2020.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
Assessing the efficacy of botulinum neurotoxin (BoNT) in vivo is essential given the growing number of BoNT products used in the clinic. Here, we evaluated the dynamic weight bearing (DWB) test for sensitivity to paralytic effects of BoNT-A following intramuscular administration. The toxin was administered into the gastrocnemius lateralis as a single bolus or into the gastrocnemius lateralis and medialis as two boluses. The effects of BoNT-A in DWB were compared to those in the compound muscle action potential (CMAP) and the Digit Abduction Score (DAS) tests. Female Sprague-Dawley rats received an acute, intramuscular (i.m.) injection of BoNT-A1 (0.1, 1, 10 pg/rat) into the right gastrocnemius muscle, while the left received vehicle. The DWB and CMAP tests were performed one-two days after the injection in order to detect the onset of sub-maximal BoNT-A activity. Both tests were preceded by the DAS test. BoNT-A produced dose-related reductions in both the weight-bearing and surface-bearing outcomes of up to 60% while showing moderate activity in the DAS. BoNT-A effects in the DWB test were well-aligned with those in the CMAP test, which showed dose-dependent reductions in CMAP amplitude and the area under the curve (AUC; up to 100%) as well as increases in latency (up to 130%). The efficacy of BoNT-A in DWB and CMAP was more pronounced with two boluses. Thus, the DWB test can be used to assess the properties of BoNTs following i.m. administration. It can be used to assess the candidate therapies and is more ethical than the mouse lethality assay.
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Affiliation(s)
- Sylvie Cornet
- Ipsen Innovation, 5 Avenue du Canada, 91940, Les Ulis, France
| | - Cindy Périer
- Ipsen Innovation, 5 Avenue du Canada, 91940, Les Ulis, France
| | - Stéphanie Wagner
- Neurofit SAS, 850 Boulevard Sébastien Brant, Bioparc 1, Parc d'Innovation, 67400, Illkirch, France
| | - Emile Andriambeloson
- Neurofit SAS, 850 Boulevard Sébastien Brant, Bioparc 1, Parc d'Innovation, 67400, Illkirch, France
| | - Bruno Pouzet
- BeVivo GmbH, Christoph Merian-Ring 11, 4153, Reinach (BL), Switzerland
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Trosch RM, Misra VP, Maisonobe P, Om S. Impact of abobotulinumtoxinA on the clinical features of cervical dystonia in routine practice. Clin Park Relat Disord 2020; 3:100063. [PMID: 34316644 PMCID: PMC8298811 DOI: 10.1016/j.prdoa.2020.100063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The efficacy and safety of abobotulinumtoxinA in the management of cervical dystonia has been established in randomized, controlled trials that use a selected trial population. In this meta-analysis of observational data, we evaluated the real-life effectiveness of abobotulinumtoxinA as delivered in routine clinical practice. METHODS Meta-analysis of patient-level data for adult patients with cervical dystonia treated with abobotulinumtoxinA from three prospective, multicenter, observational studies (NCT01314365, NCT00833196 and NCT01753349). RESULTS We report data for patients treated with abobotulinumtoxinA over one injection cycle at 181 neurology centers in 35 countries. CD clinical features as assessed by Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) Total scores (N = 920) significantly reduced by a mean [95%CI] of -12.9 [-13.9, -11.8] points at Week 4 (N = 449) and -3.2 [-3.8, -2.7] points at the end of the injection cycle (N = 890). All three TWSTRS domains (symptom severity, disability and pain) contributed to the overall improvement. Patients were generally content with symptom control at peak effect of the treatment cycle, with 86% reporting overall satisfaction. CONCLUSION Findings from this meta-analysis of observational studies confirm the effectiveness of abobotulinumtoxinA in routine practice. Despite inclusion of a broader population sample, the magnitude of improvements observed is consistent with that seen in the pivotal, randomized controlled trials.
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Affiliation(s)
- Richard M Trosch
- The Parkinson's and Movement Disorders Center, Farmington Hills, 48334, MI, USA
| | - Vijay P Misra
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Pascal Maisonobe
- Ipsen, 65 Quai Georges Gorse, 92100 Boulogne-Billancourt, France
| | - Savary Om
- Ipsen, 65 Quai Georges Gorse, 92100 Boulogne-Billancourt, France
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70
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Korsunskaya LL, Mikliaiev OO, Matyazhova NA, Sidorenko NA, Romensky AO, Torgovyi DI, Kuzmishchenko IV, Krapro JA, Torgovaya MV. [Cervical myelopathy in the hyperkinetic form of cerebral palsy: combination of botulinum therapy with surgical treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:92-97. [PMID: 32307417 DOI: 10.17116/jnevro202012002192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article describes the case of cervical myelopathy with tetraparesis and sphincter disorders, as a complication of cervical dystonia in a patient with hyperkinetic form of cerebral palsy. Left-side laterocollis in combination with the same side laterocaput was noted. Myelopathy symptoms progressed gradually over one year. The main clinical problems were: the inability to conduct a qualitative MRI study due to hyperkinesis, which required anesthesia, and the high risk of perioperative complications and relapses of cervical myelopathy. Before the surgery, botulinum therapy of cervical dystonia with abobotulotoxin in the total dose 1000ED was administered that led to regression of hyperkinesis. Microsurgical decompression of the spinal canal with the installation of fixation system at the level of C7-Th1 vertebrae was performed. After surgery, the neck was fixed with a Philadelphia collar. There were no complications after surgery or displacement of the stabilizing structure. This case report indicates the possibility of development of cervical myelopathy in cervical dystonia and demonstrates the need of pre - and post-operative botulinum therapy of cervical dystonia to prevent possible complications and relapses in the postoperative period.
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Affiliation(s)
- L L Korsunskaya
- Vernadsky Crimean Federal University of the Georgievsky Crimean Medical Academy, Simferopol, Russia
| | - O O Mikliaiev
- Vernadsky Crimean Federal University of the Georgievsky Crimean Medical Academy, Simferopol, Russia
| | - N A Matyazhova
- Vernadsky Crimean Federal University of the Georgievsky Crimean Medical Academy, Simferopol, Russia
| | - N A Sidorenko
- Semashko Republican Clinical Hospital, Simferopol, Russia
| | - A O Romensky
- Semashko Republican Clinical Hospital, Simferopol, Russia
| | - D I Torgovyi
- Semashko Republican Clinical Hospital, Simferopol, Russia
| | | | - J A Krapro
- Semashko Republican Clinical Hospital, Simferopol, Russia
| | - M V Torgovaya
- Semashko Republican Clinical Hospital, Simferopol, Russia
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71
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Khatkova SE, Kostenko EV, Akulov MA, Diagileva VP, Nikolaev EA, Orlova AS. [Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:43-50. [PMID: 32207717 DOI: 10.17116/jnevro201911912243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of rehabilitation of post-stroke patients with motor deficit remains relevant with growing prevalence of disability and decreasing mortality, despite all measures aimed at stroke prevention and morbidity reduction. One of the most common consequences of stroke is gait impairment as a result of spastic paresis of the lower limb (decreased gait velocity, shortened step, excessive loading of intact limb etc.), which leads to significant maladaptation, increased risk of falls, decrease in quality of life. The article presents a detailed review of motor action in normal and pathologic conditions, analysis of neuronal structures involved into a movement act in healthy individuals and in stroke patients, current aspects of gait pathophysiology, characteristics of post-stroke gait (speed and asymmetry of gain, balance control impairment). A separate paragraph is devoted to gait recovery after stroke with analysis of existing and developing strategies of rehabilitation, aimed at the improvement of vertical posture, balance control and movement, condition, tone and functioning of skeletal muscles. Authors also analyze new research information on the efficacy of botulinum toxin preparations and programs of Guided Self-Rehabilitation Contracts (GSC), present the results of clinical trials demonstrating the efficacy of combination of these two methods.
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Affiliation(s)
- S E Khatkova
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E V Kostenko
- Burdenko National Scientific and Practical Centre for Neurosurgery, Moscow, Russia
| | - M A Akulov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V P Diagileva
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E A Nikolaev
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical University, Moscow, Russia
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What clinicians and patients want: The past, the presence, and the future of the botulinum toxins. Toxicon 2020; 177:46-51. [DOI: 10.1016/j.toxicon.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
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73
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Comments on Immunogenicity Associated with Botulinum Toxin Treatment. Toxins 2019, 11, 491. Toxins (Basel) 2020; 12:toxins12020071. [PMID: 31979238 PMCID: PMC7076756 DOI: 10.3390/toxins12020071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/20/2020] [Indexed: 12/04/2022] Open
Abstract
In contrast to the prevailing arguments presented in the current review, the incidence of neutralising antibody (NAb) formation is not a significant issue for any of the present type A therapeutic botulinum neurotoxin (BoNT) products. Furthermore, clinical non-responsiveness is poorly correlated with the presence of NAbs. The overriding evidence supports the view that the rate of NAb formation is low, does not differ significantly between the different type A BoNT products and that it is not the major factor in clinical response. BoNT products are highly effective and important therapies for the treatment of a variety of neurological and non-neurological conditions.
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Carruthers JD, Fagien S, Joseph JH, Humphrey SD, Biesman BS, Gallagher CJ, Liu Y, Rubio RG. DaxibotulinumtoxinA for Injection for the Treatment of Glabellar Lines: Results from Each of Two Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase 3 Studies (SAKURA 1 and SAKURA 2). Plast Reconstr Surg 2020; 145:45-58. [PMID: 31609882 PMCID: PMC6940025 DOI: 10.1097/prs.0000000000006327] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/31/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin type A formulation in clinical development. A phase 2 dose-ranging study identified an optimal dose and demonstrated efficacy with a median duration of 24 weeks. METHODS In two phase 3, multicenter, randomized, double-blind, placebo-controlled studies (SAKURA 1 and SAKURA 2), subjects with moderate or severe glabellar lines at maximum frown were assigned randomly to receive placebo or 40 U of DAXI. Glabellar lines were evaluated at least every 4 weeks for at least 24 weeks until severity returned to baseline (≤36 weeks). RESULTS Overall, 609 subjects were enrolled (DAXI, n = 405; placebo, n = 204). DAXI was significantly more effective than placebo in achieving the primary efficacy outcome (≥2-point improvement in glabellar line severity at maximum frown at week 4 according to both investigator and subject ratings): 73.6 percent versus 0.0 percent (SAKURA 1), and 74.0 percent versus 1.0 percent (SAKURA 2) (both p < 0.0001). Composite investigator and subject ratings of maximum frown after DAXI treatment showed that glabellar line severity of none or mild was maintained for a median of 24.0 weeks (SAKURA 1) and 23.9 weeks (SAKURA 2), and glabellar line severity did not return to baseline levels for a median of 27.7 and 26.0 weeks, respectively. DAXI was generally well tolerated, with the most common adverse events related to DAXI treatment being headache (SAKURA 1, 7.0 percent; SAKURA 2, 5.9 percent) and injection-site pain (5.0 percent and 2.4 percent, respectively). CONCLUSIONS Results from both studies were highly consistent. DAXI may offer a prolonged duration of response (median, ≥24 weeks) and is generally well tolerated. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Affiliation(s)
- Jean D. Carruthers
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Steve Fagien
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - John H. Joseph
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Shannon D. Humphrey
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Brian S. Biesman
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Conor J. Gallagher
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Yan Liu
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
| | - Roman G. Rubio
- From the Departments of Ophthalmology and Visual Sciences and Dermatology and Skin Science, University of British Columbia; private practice; Clinical Testing of Beverly Hills; and Revance Therapeutics, Inc
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Warren H, Welch K, Coquis-Knezek S. AbobotulinumtoxinA for Facial Rejuvenation: What Affects the Duration of Efficacy? Plast Surg Nurs 2020; 40:37-44. [PMID: 32102079 DOI: 10.1097/psn.0000000000000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AbobotulinumtoxinA (Dysport) has a long history as a safe and effective treatment option for aesthetic rejuvenation. One of the key measures of botulinum toxin efficacy is the persistence of clinically meaningful results. The duration of efficacy depends on different factors, many of which can be controlled by the clinician to better achieve their desired results. In this review, we discuss how dose, individual patient variation, and injection technique affect the duration of botulinum toxins. Increased duration may result from increased dose or more precise placement of the toxin in the muscle. The varying anatomy and behavior of patients can affect duration as well. Measures of duration in clinical studies vary, but both a 1-grade improvement on the glabellar line severity scale and patient-reported outcomes are key measures. The clinical effects of Dysport can last up to 5 months, and patients in Dysport clinical studies remained satisfied with treatment for up to 6 months. Dysport has a legacy of safety, efficacy, and high subject satisfaction demonstrated through studies and clinical experience. Building on that legacy by correctly dosing the subject, properly accounting for the individual subject anatomy and behavior, and using specific injection techniques can help ensure that your patients have the longest lasting results.
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Affiliation(s)
- Hermine Warren
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
| | - Kim Welch
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
| | - Sarah Coquis-Knezek
- Hermine Warren, DNP, APRN, CANS, CNM, is an advanced practice RN, GenNow faculty and a GAIN trainer for Galderma. She is also PALETTE faculty. She is at Facialogy Medical, Inc., Encino, CA
- Kim Welch, BSN, RN, CANS, is an aesthetics specialist GenNow faculty and a GAIN trainer for Galderma. She is at Esperance Aesthetic Wellness, Coppell, TX
- Sarah Coquis-Knezek, PhD, is an associate medical affairs advisor at Galderma Laboratories, L.P., Fort Worth, TX
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Bertucci V, Solish N, Kaufman-Janette J, Yoelin S, Shamban A, Schlessinger J, Snyder D, Gallagher C, Liu Y, Shears G, Rubio RG. DaxibotulinumtoxinA for Injection has a prolonged duration of response in the treatment of glabellar lines: Pooled data from two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). J Am Acad Dermatol 2019; 82:838-845. [PMID: 31791824 DOI: 10.1016/j.jaad.2019.06.1313] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/05/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin type A in clinical development. Phase 2 data have shown it offers a more prolonged duration of response than onabotulinumtoxinA. OBJECTIVE To further evaluate the efficacy, duration of response, and safety of 40 U DAXI compared with placebo in the treatment of glabellar lines. METHODS Two identical, multicenter, randomized, double-blind, placebo-controlled, phase 3 studies were performed (NCT03014622 and NCT03014635 on www.clinicaltrials.gov). Participants with moderate or severe glabellar lines were randomly assigned (2:1) to receive 40 U DAXI or placebo into the corrugator/procerus muscles. Glabellar line severity was assessed by investigators and participants for up to 36 weeks (≥24 weeks). RESULTS Among 609 participants enrolled (405 DAXI, 204 placebo), 92% completed. DAXI was significantly more effective than placebo in reducing glabellar line severity and maintained none or mild glabellar line severity for a median of 24.0 weeks. It was also generally well tolerated-treatment-related adverse effects were most commonly headache (6.4% vs 2.0%) and injection site pain (3.7% vs 3.9%). LIMITATIONS The study population was predominantly female and white and received only a single treatment. CONCLUSIONS DAXI offers a prolonged duration of response for glabellar line reduction and is well tolerated.
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Affiliation(s)
- Vince Bertucci
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada; private practice, Woodbridge, Ontario, Canada.
| | - Nowell Solish
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Joely Kaufman-Janette
- Skin Associates of South Florida, Coral Gables, and Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Coral Gables, California
| | | | | | | | | | | | - Yan Liu
- Revance Therapeutics, Inc, Newark, California
| | - Gill Shears
- Write on Target Ltd, Leighton Buzzard, United Kingdom
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Kovalenko AP, Misikov VK, Iskra DA, Koshkarev MA, Sinelnikov KA. [Tardue scales in the diagnostic of spasticity]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:83-90. [PMID: 31626223 DOI: 10.17116/jnevro201911909183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).
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Affiliation(s)
- A P Kovalenko
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - V K Misikov
- Vladimirsky Moscow Region Research and Clinical Institute, Moscow, Russia
| | - D A Iskra
- Kirov Military Medical Academy, St. Petersburg, Russia
| | | | - K A Sinelnikov
- Central Military Clinical Hospital, Sergiev Posad, Russia ,Pokrovskaya City Hospital, St. Petersburg, Russia
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Immunogenicity Associated with Botulinum Toxin Treatment. Toxins (Basel) 2019; 11:toxins11090491. [PMID: 31454941 PMCID: PMC6784164 DOI: 10.3390/toxins11090491] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022] Open
Abstract
Botulinum toxin (BoNT) has been used for the treatment of a variety of neurologic, medical and cosmetic conditions. Two serotypes, type A (BoNT-A) and type B (BoNT-B), are currently in clinical use. While considered safe and effective, their use has been rarely complicated by the development of antibodies that reduce or negate their therapeutic effect. The presence of antibodies has been attributed to shorter dosing intervals (and booster injections), higher doses per injection cycle, and higher amounts of antigenic protein. Other factors contributing to the immunogenicity of BoNT include properties of each serotype, such as formulation, manufacturing, and storage of the toxin. Some newer formulations with purified core neurotoxin devoid of accessory proteins may have lower overall immunogenicity. Several assays are available for the detection of antibodies, including both structural assays such as ELISA and mouse-based bioassays, but there is no consistent correlation between these antibodies and clinical response. Prevention and treatment of antibody-associated non-responsiveness is challenging and primarily involves the use of less immunogenic formulations of BoNT, waiting for the spontaneous disappearance of the neutralizing antibody, and switching to an immunologically alternate type of BoNT.
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Association of Long-Term Treatment by Botulinum Neurotoxins and Occupational Therapy with Subjective Physical Status in Patients with Post-Stroke Hemiplegia. Toxins (Basel) 2019; 11:toxins11080453. [PMID: 31382438 PMCID: PMC6723584 DOI: 10.3390/toxins11080453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/02/2022] Open
Abstract
The short-term effects of botulinum toxin type A (BoNT-A) treatment in stroke patients with upper extremity are well established. This study examined the association between the recovery of motor function of the upper extremity with subjective physical symptoms in outpatients receiving long-term BoNT-A and occupational therapy following stroke. We also investigated the expectations of patients who elected to continue treatment. Forty-seven patients (23 men and 24 women) aged 61 years received BoNT-A treatment more than 20 times. The subjective physical status was analyzed by using the visual analogue scale score through an eight-item questionnaire. Recovery of motor function in the upper extremity was detected by calculating the change (delta) in Fugl–Mayer Assessment (FMA), and ordinal logistic modeling analysis was used to determine the association between the delta-FMA score and the subjective level of agreement for each item. When the ordinal logistic modeling fit was statistically significant, results were interpreted as having logistic probability. The logistic curves discriminating one point (strongly disagree) from five points (strongly agree) were fit in a stepwise fashion. This study suggests that patients receiving long-term BoNT-A treatment and occupational therapy experienced an increased upper extremity mitigation and decreased insomnia after injection, regardless of the recovery of motor function.
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da Silva AR, Anholeti MC, Pietroluongo M, Sanchez EF, Valverde AL, de Paiva SR, Figueiredo MR, Kaplan MAC, Fuly AL. Utilization of the Plant Clusia Fluminensis Planch & Triana Against Some Toxic Activities of the Venom of Bothrops jararaca and B. jararacussu Snake Venom Toxic Activities. Curr Top Med Chem 2019; 19:1990-2002. [PMID: 31339072 DOI: 10.2174/1568026619666190724160711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND In Brazil, the Bothrops genus accounts for 87% of registered snakebites, which are characterized by hemorrhage, tissue necrosis, hemostatic disturbances, and death. The treatment recommended by governments is the administration of specific antivenoms. Although antivenom efficiently prevents venom-induced lethality, it has limited efficacy in terms of preventing local tissue damage. Thus, researchers are seeking alternative therapies able to inhibit the main toxic effects of venoms, without compromising safety. OBJECTIVE The study aimed to test the ability of aqueous extracts of leaves, stems, and fruits of the plant Clusia fluminensis to neutralize some toxic effects induced by the venoms of Bothrops jararaca and Bothrops jararacussu. METHODS The plant extracts were incubated with venoms for 30 min. at 25 °C, and then in vitro (coagulant and proteolytic) and in vivo (hemorrhagic, myotoxic, and edematogenic) activities were evaluated. In addition, the extracts were administered to animals (by oral, intravenous or subcutaneous routes) before or after the injection of venom samples, and then hemorrhage and edema assays were performed. In addition, a gel solution of the fruit extract was produced and tested in terms of reducing hemorrhage effects. A chemical prospection was performed to identify the main classes of compounds present in the extracts. RESULTS All the extracts inhibited the activities of the two venoms, regardless of the experimental protocol or route of administration of the extracts. Moreover, the gel of the fruit extract inhibited the venom-induced-hemorrhage. The extracts comprised of tannins, flavonoids, saponins, steroids, and terpenoids. CONCLUSION Antivenom properties of C. fluminensis extracts deserve further investigation in order to gain detailed knowledge regarding the neutralization profile of these extracts.
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Affiliation(s)
| | | | | | - Eladio Flores Sanchez
- Research and Development Center, Ezequiel Dias Foundation, Belo Horizonte, MG, Brazil
| | | | | | | | | | - André Lopes Fuly
- Department of Cellular and Molecular Biology, Fluminense Federal University, RJ, Brazil
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Correction: Field, M. et al. AbobotulinumtoxinA (Dysport ®), OnabotulinumtoxinA (Botox ®), and IncobotulinumtoxinA (Xeomin ®) Neurotoxin Content and Potential Implications for Duration of Response in Patients. Toxins (Basel) 2019; 11:toxins11020115. [PMID: 30781899 PMCID: PMC6410060 DOI: 10.3390/toxins11020115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
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The whole truth about botulinum toxin - a review. Postepy Dermatol Alergol 2019; 37:853-861. [PMID: 33603602 PMCID: PMC7874868 DOI: 10.5114/ada.2019.82795] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Abstract
Treatment with botulinum toxin is widely viewed as safe, effective and largely devoid of serious side effects. There are two classes of Botox-related adverse events – transient and benign events, and potentially serious events. The aim of this study was to provide an overview of Botox-related side effects and advise potential management and preventive strategies. Benign side effects are well-localized, reversible and self-limited complications which develop within a few days of the injection, and they usually disappear without any treatment. The aesthetic and functional adverse effects are associated with different muscle responses to botulinum toxin or with misplacement of botulinum toxin. The serious events are sequelae due to the systemic spread of toxin leading to botulism.
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