Evaluation of the Safety and Efficacy of a Biosimilar Abobotulinum Toxin Type A in Treating Moderate to Severe Glabellar Lines: A Non-Inferiority Double Blinded Randomized Controlled Trial

BACKGROUND

Injection of botulinum toxin for cosmetic purposes is a well-established practice.

OBJECTIVES

This study was conducted to compare the safety and efficacy of Dyston^® (investigational biosimilar abobotulinumtoxinA) with Dysport^® (abobotulinumtoxinA, Ipsen) in the treatment of moderate to severe glabellar lines.

METHODS

Out of 193 screened subjects, 126 volunteers with moderate to severe glabellar lines fulfilling eligibility criteria were randomized in a 1:1 ratio to receive either an intramuscular injection of 40-60 units of Dyston^® or Dysport^® . The primary objective was to test the non-inferiority of Dyston^® compared to Dysport^® as measured by the percentage of volunteers who achieved no or mild glabellar lines at maximum frown assessed by the physicians based on the Glabellar Line Severity Score (GLSS) at day 30. Secondary endpoints included the improvement in the glabellar lines at maximum frown and rest states at days 14, 60, 90 and 120 as well as the side effects of the treatment.

RESULTS

Response rates at maximum frown were 75.44% (43/57) in the Dyston^® group and 76.67% (46/60) in the Dysport^® group on day 30 (P value: 0.88, 95%CI: -14.24 to 16.70, diff: 1.23) as per-protocol set, and were 75.81% (47/62) and 76.19 (48/63) (P value: 0.96, 95%CI: -14.59 to 15.35, diff: 0.3) in the Dyston^® and the Dysport^® groups, respectively, based on modified intention to treat population. Adverse events were similar in both groups and mostly mild and well-tolerated.

CONCLUSION

Treatment of moderate to severe glabellar lines with Dyston^® was effective, tolerable, and non-inferior compared to Dysport^® .

Classification of the present pharmaceutical agents based on the possible effective mechanism on the COVID-19 infection

OBJECTIVES

There are several types of research on the COVID-19 disease which have been conducting. It seems that prevailing over the pandemic would be achieved only by mastering over the virus pathophysiology. We tried to categorize the massive amount of available information for useful interpretation.

EVIDENCE ACQUISITION

We searched databases with different keywords and search strategies that focus on virulence and pathophysiology of COVID-19. The present review has aimed to gather and categorize all implemented drugs based on the susceptible virulence mechanisms, and the pathophysiological events in the host cells, discussing and suggesting treatments.

RESULTS

As a result, the COVID-19 lifecycle were categorized as following steps: "Host Cell Attachment" which is mainly conducted with ACE2 receptors and TMPRSS2 from the host cell and Spike (S) protein, "Endocytosis Pathway" which is performed mainly by clathrin-mediated endocytosis, and "Viral Replication" which contains translation and replication of RNA viral genome. The virus pathogenicity is continued by "Inflammatory Reactions" which mainly caused moderate to severe COVID-19 disease. Besides, the possible effective therapeutics' mechanism and the pharmaceutical agents that had at least one experience as a preclinical or clinical study on COVID-19 were clearly defined.

CONCLUSION

The treatment protocol would be occasional based on the stage of the infection and the patient situation. The cocktail of medicines, which could affect almost all mentioned stages of COVID-19 disease, might be vital for patients with severe phenomena. The classification of the possible mechanism of medicines based on COVID-19 pathogenicity.