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Fisher E. Applications for Neurotoxins in the Face and Neck. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:7-14. [PMID: 38307637 DOI: 10.1016/j.cxom.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Elda Fisher
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University; ASOD - Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill, 149 Brauer Hall, CB 7450, Chapel Hill, NC 27599, USA.
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da Cunha ALG, Vasconcelos R, Di Sessa D, Sampaio G, Ramalhoto P, Zampieri BF, Deus BS, Vasconcelos S, Bellote T, Carvalho J, Petrone G, Figueredo V, Limongi Moreira G. IncobotulinumtoxinA for the Treatment of Glabella and Forehead Dynamic Lines: A Real-Life Longitudinal Case Series. Clin Cosmet Investig Dermatol 2023; 16:697-704. [PMID: 36987400 PMCID: PMC10040156 DOI: 10.2147/ccid.s391709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023]
Abstract
Background There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit. Purpose To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting. Patients and Methods We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score. Results At D15, 18 (90%; 95% CI: 80%-100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65-90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55-85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35-75%) and 8 (40%; 95% CI: 25-55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30-70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0. Conclusion As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.
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Affiliation(s)
| | - Rossana Vasconcelos
- Nomina Clinica Médica De Cirurgia Plástica, Dermatologia e Oncologia, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Gustavo Limongi Moreira
- DSL Clínica Médica, São Paulo, SP, Brazil
- Correspondence: Gustavo Limongi Moreira, DSL Clínica Médica, Rua Pamplona 145 / 1717, Jardim Paulista, Sao Paulo, SP, 01405-900, Brazil, Email
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Hemasian H, Abedini F, Arab A, Khorvash F. A novel technique of botulinum toxin injection around skull sutures for chronic migraine: A randomized controlled clinical trial. J Res Med Sci 2022; 27:85. [PMID: 36685024 PMCID: PMC9854915 DOI: 10.4103/jrms.jrms_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
Background Migraine is a chronic headache manifested with attacks. Here we aimed to evaluate and compare the efficacy of 15-point Dysport injection with 31-point Xeomin injections. Materials and Methods This is a randomized clinical trial performed in 2020-2021 in Isfahan on patients with refractory chronic migraine. A total number of 60 patients entered the study. The pain of patients was also determined using headache impact test (HIT) questionnaire. Patients were randomized into two groups: Group 1 underwent 31-point Xeomin injection and Group 2 underwent 1 vial of Dysport injection into 15 points of the scalp. Results Our study revealed that the data regarding aura, nausea, vomit, photosensitivity, sensitivity to sounds and smells did not change significantly between two groups compared to the beginning of the study. Frequency, duration, intensity of headaches, and the mean HIT score of all patients improved significantly within 3 months after interventions. Comparing both groups showed no significant differences (P > 0.05). HIT score was decreased from 21.26 ± 3.58 before intervention to 15.51 ± 4.58 after 3 months in Group 1 and 22.23 ± 2.59-10.33 ± 2.26 in Group 2. In both groups, these changes were statistically significant (P < 0.001). Although we found more decrease of HIT score in Group 2 comparing with Group 1 (10.33 ± 2.26 vs. 15.51 ± 4.58), this difference was not statistically significant (P = 0.12). Conclusion Although Xeomin and Dysport injections are both effective and reduced pain in patients with chronic migraine, our new technique is probably better than the standard technique. Because the injection points are halved, increase patients comfort and reduce overall cost.
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Affiliation(s)
- Helia Hemasian
- Department of Neurology, School of Medicine, Firouzgar Hospital, Iran University of Medical Science, Tehran, Iran
| | - Faezeh Abedini
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Firouzgar Hospital, Iran University of Medical Science, Tehran, Iran,Address for correspondence: Dr. Fariborz Khorvash, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Pecora CDS, Ferreira KV, Miot HA. The ONE21 technique for an individualized assessment and treatment of upper face wrinkles in five pairs of identical twins with IncobotulinumtoxinA. J Cosmet Dermatol 2022; 21:1940-1947. [PMID: 35201665 DOI: 10.1111/jocd.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Facial aging is a complex process, which, beyond a genetic predisposition, involves both physical and environmental factors. Even identical twins with the same genetic load may differ substantially in facial wrinkles and aging, demanding a personalized treatment approach. OBJECTIVE To demonstrate the ONE21 technique as an excellent tool to a customized assessment and IncobotulinuntoxinA treatment to address phenotype discordances and epigenetic drifts in identical twins, expressed by different patterns of upper face muscle contractions and wrinkles intensity. PATIENTS / METHODS Five pairs of identical Caucasian twin sisters, from 30 to 45 years old, were evaluated for hyperfunctional upper facial wrinkles (forehead, glabella and periorbital), assessing the individual anatomy, muscle function and habitual facial movements of each patient. All the subjects were treated with the ONE21 technique using IncobotulinumtoxinA and reevaluated 30 days after the procedure. RESULTS Though the clinical-anatomical pattern of the forehead contraction was similar between the pairs, the strength of the muscles, the number and depth of wrinkles differed. This varied presentation demanded distinct points of distribution and dosages of incobotulinumtoxinA for all the twins, according to the ONE21 approach. The results 30 days after treatment were satisfactory in all the subjects. CONCLUSION The ONE21 technique allows an objective and careful evaluation of the wrinkles of the upper face, based on an individualized assessment, which may vary even in identical twins.
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Kazerooni R, Howard IM, Keener AM, Bounthavong M. Real-World Six-Year National Cost-Minimization Analysis of IncobotulinumtoxinA and OnabotulinumtoxinA in the VA/DoD Healthcare Systems. Clinicoecon Outcomes Res 2021; 13:603-609. [PMID: 34234482 PMCID: PMC8256819 DOI: 10.2147/ceor.s320212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/15/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose This study sought to perform a real-world, long-term cost-minimization analysis for incobotulinumtoxinA (Xeomin®) versus onabotulinumtoxinA (Botox®), given the established non-inferiority when utilized at similar doses. Methods The Department of Veterans Affairs (VA) and Department of Defense (DoD) national healthcare systems were included in this analysis. Real-world purchase data for incobotulinumtoxinA were used to estimate the direct drug costs between calendar years 2014 and 2019. Publicly available federal pharmaceutical prices (Federal Supply Schedule and Big 4) were used. The primary outcome was the difference in total direct costs nationally for incobotulinumtoxinA (real-world) versus having hypothetically utilized onabotulinumtoxinA (projected) for similar utilization. Sites utilizing ≥100 vials (of 100 Unit equivalents) of incobotulinumtoxinA annually were categorized as “major adopters”. IncobotulinumtoxinA 50 Unit vials were assumed to be an alternative to a 100 Unit vial of onabotulinumtoxinA for 50% of such vial purchases in the base case scenario to account for differences in wastage. Results Over the six-year study time frame, 156 sites (76.8%) utilized incobotulinumtoxinA of the 203 total VA healthcare systems and DoD medical centers. Of these sites, 67 were major adopters for at least one year, with a mean of 3.4 years spent as a major adopter over the study period. Average annual savings per major adopter was $105,782. IncobotulinumtoxinA costs for all VA/DoD sites was $46.39 million for the six-year period versus a projected $71.92 million onabotulinumtoxinA cost—a total savings of $25.53 million (35.5% relative reduction). Approximately, 82.8% of savings stemmed from lower drug acquisition cost ($21.14 million) and 17.2% of savings ($4.39 million) was related to reduced wastage. It was estimated that a total of 9958 extra onabotulinumtoxinA 100 Unit vials would have been wasted during the six-year period, translating to the need for a 5.9% increase in vial purchases versus incobotulinumtoxinA. Conclusion Meaningful cost savings were realized related to incobotulinumtoxinA adoption over a long-term time frame in the VA/DoD healthcare systems.
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Affiliation(s)
| | - Ileana M Howard
- Rehabilitation Care Services, VA Puget Sound, Seattle, WA, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA.,Parkinson's Disease Research, Education, and Clinical Center, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
| | - Mark Bounthavong
- VA Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Clinical Pharmacy, UCSD Skaggs School of Pharmacy & Pharmaceutical Sciences, San Diego, CA, USA
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Jog M, Lee J, Scheschonka A, Chen R, Ismail F, Boulias C, Hobson D, King D, Althaus M, Simon O, Dersch H, Frucht S, Simpson DM. Tolerability and Efficacy of Customized IncobotulinumtoxinA Injections for Essential Tremor: A Randomized, Double-Blind, Placebo-Controlled Study. Toxins (Basel) 2020; 12:807. [PMID: 33419261 DOI: 10.3390/toxins12120807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
In this first, double-blind, randomized, placebo-controlled exploratory trial, we evaluate the efficacy and safety of incobotulinumtoxinA and feasibility of using kinematic tremor assessment to aid in the planning of muscle selection in a multicenter setting. Reproducibility of the planning technology to other clinical sites was explored. In this trial (NCT02207946), patients with upper-limb essential tremor (ET) were randomized 2:1 to a single treatment cycle of incobotulinumtoxinA or placebo. A tremor kinematic analytics investigational device was used to define a customized muscle set for injection, related to the pattern of the wrist, forearm, elbow, and shoulder tremor for each patient, and the incobotulinumtoxinA dose per muscle (total ≤ 200 U). Fahn–Tolosa–Marin (FTM) Part B motor performance score, Global Impression of Change Scale (GICS), and kinematic analysis-based efficacy evaluations were assessed. Thirty patients were randomized (incobotulinumtoxinA, n = 19; placebo, n = 11). FTM motor performance scores showed greater improvement with incobotulinumtoxinA versus placebo at Week 4 (p= 0.003) and Week 8 (p= 0.031). The physician-rated GICS score indicated improvement with incobotulinumtoxinA versus placebo at Week 4 (p < 0.05). IncobotulinumtoxinA also decreased accelerometric hand-tremor amplitude versus placebo from baseline to Week 4 (p= 0.004) and Week 8 (p < 0.001), with persistent tremor reduction up to 24 weeks post-injection. IncobotulinumtoxinA produced a slight and transient reduction of maximal grip strength versus placebo; two patients reported localized finger muscle weakness. Customized incobotulinumtoxinA injections decreased tremor severity and improved hand motor function in patients with upper-limb ET after a single injection cycle, with a favorable tolerability profile. The study showed that tremor kinematic analytics technology could be successfully scaled for use in other clinical sites.
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Shome D, Vadera S, Shiva Ram M, Kapoor R. Efficacy of Incobotulinum toxin-A for the treatment of masseter muscle hypertrophy in Asian Indian patients: A 2-year follow-up study. J Cosmet Dermatol 2020; 19:1892-1899. [PMID: 32539203 DOI: 10.1111/jocd.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND With the changing trends, more and more patients are opting for nonsurgical or minimally invasive options for reshaping the face. Noninvasive treatments such as incobotulinumtoxinA (Xeomin Cosmetic® ; Merz Pharma Canada Ltd., Burlington, ON, Canada) are a preferred modality for reducing the volume of the muscle and therefore reducing the width of masseter. AIMS To evaluate the efficacy of Xeomin treatment in long-term management of bilateral masseter hypertrophy in Asian Indian patients. PATIENTS/METHODS A total of 30 patients were enrolled in the study and were injected with 30 U Xeomin on each side of face, at baseline. Fifteen patients received a second session of Xeomin injection at 12th week, and remaining 15 patients received an additional third session, at 12th and 24th weeks post the first injection, respectively. Follow-up was done at 4th-, 12th-, 24th-, and 36th-week and at first- and second-year follow-ups. RESULTS For the patients who received two injections, the maximum reduction of 26.85% was observed at 24th week, which was maintained as 20.04% reduction until second follow-up year. The patients who received three injections exhibited very high reduction of 43.12% of masseter volume at 36th week, which was maintained at 38.72 % until the second follow-up year. Three sessions of Xeomin injections were proved to be more effective in long-term maintenance of reduced masseter volume than 2 sessions of injections. CONCLUSIONS Xeomin injections were found to be effective in long-term management of bilateral masseter hypertrophy. This is the first of its kind paper, which evaluates the long-term effects of Xeomin injections for the treatment of masseter hypertrophy.
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Affiliation(s)
- Debraj Shome
- Department of Facial Plastic Surgery, The Esthetic Clinics, Mumbai, India
| | - Sapna Vadera
- Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Male Shiva Ram
- The Esthetic Clinics & School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology and Dermato-Surgery, The Esthetic Clinics, Mumbai, India
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Rupp D, Nicholson G, Canty D, Wang J, Rhéaume C, Le L, Steward LE, Washburn M, Jacky BP, Broide RS, Philipp-Dormston WG, Brin MF, Brideau-Andersen A. OnabotulinumtoxinA Displays Greater Biological Activity Compared to IncobotulinumtoxinA, Demonstrating Non-Interchangeability in Both In Vitro and In Vivo Assays. Toxins (Basel) 2020; 12:toxins12060393. [PMID: 32545832 PMCID: PMC7354455 DOI: 10.3390/toxins12060393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Abstract
Differences in botulinum neurotoxin manufacturing, formulation, and potency evaluation can impact dose and biological activity, which ultimately affect duration of action. The potency of different labeled vials of incobotulinumtoxinA (Xeomin®; 50 U, 100 U, or 200 U vials; incobotA) versus onabotulinumtoxinA (BOTOX®; 100 U vial; onabotA) were compared on a unit-to-unit basis to assess biological activity using in vitro (light-chain activity high-performance liquid chromatography (LCA-HPLC) and cell-based potency assay (CBPA)) and in vivo (rat compound muscle action potential (CMAP) and mouse digit abduction score (DAS)) assays. Using LCA-HPLC, incobotA units displayed approximately 54% of the protease activity of label-stated equivalent onabotA units. Lower potency, reflected by higher EC50, ID50, and ED50 values (pooled mean ± SEM), was displayed by incobotA compared to onabotA in the CBPA (EC50: incobotA 7.6 ± 0.7 U/mL; onabotA 5.9 ± 0.5 U/mL), CMAP (ID50: incobotA 0.078 ± 0.005 U/rat; onabotA 0.053 ± 0.004 U/rat), and DAS (ED50: incobotA 14.2 ± 0.5 U/kg; onabotA 8.7 ± 0.3 U/kg) assays. Lastly, in the DAS assay, onabotA had a longer duration of action compared to incobotA when dosed at label-stated equivalent units. In summary, onabotA consistently displayed greater biological activity than incobotA in two in vitro and two in vivo assays. Differences in the assay results do not support dose interchangeability between the two products.
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Affiliation(s)
- David Rupp
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
- Correspondence:
| | - Greg Nicholson
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - David Canty
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Joanne Wang
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Catherine Rhéaume
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Linh Le
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Lance E. Steward
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Mark Washburn
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Birgitte P. Jacky
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | - Ron S. Broide
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
| | | | - Mitchell F. Brin
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
- Department of Neurology, University of California, Irvine, Irvine, CA 92697, USA
| | - Amy Brideau-Andersen
- Allergan, an AbbVie company, Irvine, CA 92612, USA; (G.N.); (D.C.); (J.W.); (C.R.); (L.L.); (L.E.S.); (M.W.); (B.P.J.); (R.S.B.); (M.F.B.); (A.B.-A.)
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Abstract
Guidelines recommend Botulinum toxin-A (BoNT-A) after deep brain stimulation (DBS), although the effectiveness of their combined use is uncertain. A chart review of Parkinson's disease (17) and dystonia (7) patients undergoing 302 injections with IncobotulinumtoxinA before or after DBS was performed. Patients with cervical dystonia received less IncobotulinumtoxinA after DBS (290.7 ± 124.0 vs. 192.4 ± 131.4, p = 0.005) and experienced an increased benefit (4.0 ± 3.4 vs. 8.4 ± 3.6 weeks, p = 0.003). No significant differences were found when comparing the treatment outcomes of 14 patients who received both IncobotulinumtoxinA and OnabotulinumtoxinA after DBS. The use of BoNT-A after DBS is a useful strategy although prospective studies are needed.
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PrabotulinumtoxinA (Jeuveau) for frown lines. Med Lett Drugs Ther 2019; 61:79-80. [PMID: 31169802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Anido J, Arenas D, Arruabarrena C, Domínguez-Gil A, Fajardo C, Mira M, Murillo J, Ribé N, Rivera H, Ruiz Del Cueto S, Silvestre H, Tirado M. Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone. Clin Cosmet Investig Dermatol 2017; 10:413-421. [PMID: 29089780 PMCID: PMC5655032 DOI: 10.2147/ccid.s138274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Facial lines and wrinkles are strongly influenced by individual differences in anatomy and muscle activity and no single injection protocol will suit all patients. However, there is only limited information in the published literature on how to develop a tailored approach to botulinum toxin treatment. METHODS An expert panel of physicians was convened to establish a consensus on developing an individualized approach to treatment of the forehead with incobotulinumtoxinA. Separate treatment protocols were developed for men and women and subdivided by background level of muscle activity: kinetic, hyperkinetic, and hypertonic. Each muscle tone category was then further subdivided to take account of individual characteristics that can influence treatment. RESULTS Consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is described for men and women with a wide range of forehead presentations. For each presentation, units of toxin as well as the precise location of injection points were defined by creating a 12-zone map of the forehead. CONCLUSION These recommendations depart from traditional consensus documents by providing detailed incobotulinumtoxinA injection protocols for the forehead based on the major parameters that differ between patients, including muscular anatomy, size, and tone. It is expected that the use of this document will lead to more satisfactory, natural, and individualized aesthetic outcomes for patients.
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Abstract
Botulinum toxin type A (BTA) can be used for facial aesthetics. The 3 currently available BTA types include onabotulinumtoxinA (Botox; Botox Cosmetic, Allergan, Irvine, CA), abobotulinumtoxinA (Dysport; Ipsen, Ltd, Berkshire, UK), and incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals, Frankfurt, Germany). The mechanism of action and clinical uses for treatment of dynamic lines of the forehead, brow, glabella, lateral orbit, nose, and lips are presented, as well as treatment of masseter hypertrophy, platysmal bands, and improvements of the perioral region. Specific BTA injection sites and suggested doses are presented.
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Elovic EP, Munin MC, Kaňovský P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxina for upper-limb post-stroke spasticity. Muscle Nerve 2015. [PMID: 26201835 PMCID: PMC5064747 DOI: 10.1002/mus.24776] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Efficacy and safety of incobotulinumtoxinA in post-stroke upper-limb spasticity were studied. METHODS Subjects randomized 2:1 to incobotulinumtoxinA (fixed dose 400 U) or placebo, with fixed doses for the primary target clinical pattern (PTCP; flexed elbow, 200 U; flexed wrist, 150 U; clenched fist, 100 U). Doses for non-primary patterns were flexible within predefined ranges. RESULTS At week 4, incobotulinumtoxinA led to larger improvements in PTCP Ashworth scale (AS) scores than placebo [least-squares mean change ± standard error: -0.9 ± 0.06 (n = 171) vs. -0.5 ± 0.08 (n = 88); P < 0.001], and more subjects were PTCP AS responders (≥1-point improvement) with incobotulinumtoxinA (69.6%) than with placebo (37.5%; P < 0.001). Investigator's Global Impression of Change confirmed superiority of incobotulinumtoxinA vs. placebo (P = 0.003). IncobotulinumtoxinA was associated with functional improvements, as demonstrated in responder rates for Disability Assessment Scale principal target at week 4 (P = 0.007). Adverse events were mainly mild/moderate, and were reported by 22.4% (incobotulinumtoxinA) and 16.8% (placebo) of subjects. CONCLUSIONS IncobotulinumtoxinA significantly improved upper-limb spasticity and associated disability, and was well-tolerated.
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Affiliation(s)
- Elie Paul Elovic
- HealthSouth Rehabilitation Hospital of Utah, 8074 South 1300 East, Sandy, Utah, 84094, USA
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Petr Kaňovský
- Faculty of Medicine and Dentistry and University Hospital, Palacky University Olomouc, Olomouc, Czech Republic
| | | | | | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Rehabilitation Institute of Chicago, Chicago, Illinois, USA
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Kazerooni R, Lim J, Ashley Blake P, Lessig S. IncobotulinumtoxinA for Migraine: A Retrospective Case Series. Clin Ther 2015; 37:1860-4. [PMID: 26166734 DOI: 10.1016/j.clinthera.2015.05.509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE IncobotulinumtoxinA is used for treating certain movement disorders but lacks published clinical data on use in chronic migraine. METHODS This retrospective case series was performed by using electronic chart reviews on patients receiving incobotulinumtoxinA for migraine at the Veterans Affairs San Diego Healthcare System between September 2013 and March 2014. Patients were administered 150 units each, with similar methods used for onabotulinumtoxinA injections. FINDINGS A total of 21 patients were included in the analysis. Patients were 40 years old on average, 67% white, and 52% female. Patients had trialed an average of 4.19 oral prophylactic agents for migraine with 43% having previous history of onabotulinumtoxinA use and 29% having a history of traumatic brain injury. Patients reported a decrease in headache days per month (19.1 vs 9.1; P < 0.001) and headache intensity (8.3 vs 4.1; P < 0.001) after incobotulinumtoxinA injections. Most patients experienced an improvement in headache frequency and/or intensity (81.8%). The duration of action for these patients averaged 81.9 days (median, 70 days). IMPLICATIONS Significant improvements in headache frequency and intensity were observed. Chronic migraine is not an indication approved by the US Food and Drug Administration for incobotulinumtoxinA; however, the drug's effectiveness was documented in this small patient population.
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Affiliation(s)
- Rashid Kazerooni
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California San Diego, San Diego, CA.
| | - Jane Lim
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California San Diego, San Diego, CA
| | - PharmD Ashley Blake
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California San Diego, San Diego, CA
| | - Stephanie Lessig
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California San Diego, San Diego, CA
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Abstract
Blepharospasm is a focal (although usually bilateral) dystonia of the orbicularis oculi muscles, producing excessive eye closure. This produces significant disability through functional blindness. Botulinum neurotoxins (BoNT) have become the treatment of choice for blepharospasm; the impressive response rate and the tolerable safety profile have been proven through multiple clinical studies. There are currently four BoNT approved in the United States for different indications - we review the data on blepharospasm for each of these drugs. Currently, incobotulinumtoxinA and onabotulinumtoxinA have the most evidence of benefit for patients with blepharospasm. Current evidence, recent development and future directions are discussed.
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Affiliation(s)
- Amy Hellman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, 988435 Nebraska Medical Center, Omaha, NE 68198, USA
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Jost WH, Benecke R, Hauschke D, Jankovic J, Kaňovský P, Roggenkämper P, Simpson DM, Comella CL. Clinical and pharmacological properties of incobotulinumtoxinA and its use in neurological disorders. Drug Des Devel Ther 2015; 9:1913-26. [PMID: 25897202 PMCID: PMC4389813 DOI: 10.2147/dddt.s79193] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background IncobotulinumtoxinA (Xeomin®) is a purified botulinum neurotoxin type A formulation, free from complexing proteins, with proven efficacy and good tolerability for the treatment of neurological conditions such as blepharospasm, cervical dystonia (CD), and post-stroke spasticity of the upper limb. This article provides a comprehensive overview of incobotulinumtoxinA based on randomized controlled trials and prospective clinical studies. Summary IncobotulinumtoxinA provides clinical efficacy in treating blepharospasm, CD, and upper-limb post-stroke spasticity based on randomized, double-blind, placebo-controlled trials with open-label extension periods (total study duration up to 89 weeks). Adverse events were generally mild or moderate. The most frequent adverse events, probably related to the injections, included eyelid ptosis and dry eye in the treatment of blepharospasm, dysphagia, neck pain, and muscular weakness in patients with CD, and injection site pain and muscular weakness when used for treating spasticity. In blepharospasm and CD, incobotulinumtoxinA was investigated in clinical trials permitting flexible intertreatment intervals based on the individual patient’s clinical need; the safety profile of intervals shorter than 12 weeks was comparable to intervals of 12 weeks and longer. There were no cases of newly formed neutralizing antibodies during the Phase III and IV incobotulinumtoxinA trials. Phase III head-to-head trials of incobotulinumtoxinA versus onabotulinumtoxinA for the treatment of blepharospasm and CD have demonstrated therapeutic equivalence of both formulations. Additional Phase III trials of incobotulinumtoxinA in conditions such as lower-limb spasticity, spasticity in children with cerebral palsy, and sialorrhea in various neurological disorders are ongoing. Conclusion IncobotulinumtoxinA is an effective, well-tolerated botulinum neurotoxin type A formulation. Data from randomized clinical trials and further observational studies are expected to help physicians to optimize treatment by tailoring the choice of formulation, dose, and treatment intervals to the patient’s clinical needs.
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Affiliation(s)
- Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg, Germany
| | - Reiner Benecke
- Clinic and Policlinic for Neurology, University of Rostock, Rostock, Germany
| | - Dieter Hauschke
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Petr Kaňovský
- Department of Neurology, Palacky University Olomouc, Faculty of Medicine and Dentistry and University Hospital, Olomouc, Czech Republic
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Fernandez HH, Jankovic J, Holds JB, Lin D, Burns J, Verma A, Sethi K, Pappert EJ. Observational Study of IncobotulinumtoxinA for Cervical Dystonia or Blepharospasm (XCiDaBLE): Interim Results for the First 170 Subjects with Blepharospasm. Tremor Other Hyperkinet Mov (N Y) 2014; 4:238. [PMID: 25120942 PMCID: PMC4107228 DOI: 10.7916/d8mk6b1b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/18/2014] [Indexed: 12/04/2022]
Abstract
Background XCiDaBLE is a large, prospective, observational “naturalistic” study evaluating Xeomin® for Cervical Dystonia or BLEpharospasm in the United States. We report the interim results from the blepharospasm cohort of XCiDaBLE. Methods Subjects (≥18 years old) with blepharospasm were followed for two treatment cycles of incobotulinumtoxinA and monitored for 4 weeks after injection via interactive voice/web response system (IVRS/IWRS). The investigator-reported scale includes the Clinical Global Impression Scale-Severity subscale (CGI-S). Patient-reported outcome measures include the Patient Global Impression Scale-Severity (PGI-S) and -Improvement (PGI-I) subscales, Jankovic Rating Scale (JRS), SF-12v2® health survey, and Work Productivity and Activity Impairment questionnaire. Subjects are seen by the investigator at baseline (including the first injection), during the second injection, and at a final study visit (12 weeks after the second injection). Results One hundred seventy subjects were included in this interim analysis. The majority of subjects were female (77.1%) and white (91.8%), and had previously been treated with botulinum toxins (96.5%). The mean total dose (both eyes) was 71.5 U of incobotulinumtoxinA for the first injection. PGI-S, PGI-I, and JRS scores were significantly improved 4 weeks after treatment (all p<0.0001). No differences were noted in either quality of life (QoL) or work productivity in this short assessment period. No unexpected adverse events occurred. Discussion This is an interim study and assessment method based on an IVRS/IWRS. In this predominantly toxin-experienced cohort, significant benefits in specific and global measures of disease severity were seen in the immediate post-incobotulinumtoxinA injection period. It will be interesting to see if there are improvements in QoL with consistent individualized injections over a longer period.
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Affiliation(s)
| | | | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc., Des Peres, MO, USA
| | - Daniel Lin
- Michigan Neuro-ophthalmology & Oculoplastics, PLC, Warren, MI, USA
| | - John Burns
- Ophthalmic Surgeons and Consultants of Ohio, Columbus, OH, USA
| | - Amit Verma
- Merz North America, Inc., Greensboro, NC, USA
| | - Kapil Sethi
- Merz North America, Inc., Greensboro, NC, USA ; Georgia Health Sciences University, Atlanta, GA, USA
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