A comparative assessment of three formulations of botulinum toxin A for facial rhytides: a systematic review and meta-analyses

Abstract

BackgroundBotulinum toxin A is a commonly used biological medication in the field of facial plastic surgery. Currently, there are three distinct formulations of botulinum toxin A, each with their purported benefits and advantages. However, there is considerable confusion as to the relative efficacy and side-effects associated with each formulation. Therefore, the purpose of this paper is to systematically assess published studies and perform a meta-analysis to determine if there is a significant advantage of any of the individual formulations.Methods/designA systematic literature search was performed for all relevant English language randomized controlled trials using Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, World Health Organization (WHO) International Clinical Trials Registry Platform, European Union (EU) Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Inclusion criteria included any randomized controlled trial (RCT) that assessed the use of botulinum toxin for cosmetic purposes. The included articles were also analyzed for bias using the Cochrane Collaboration’s tool for assessing the risk of bias in RCTs.DiscussionThe results of this review will provide clinicians with an unbiased, high level of evidence of the comparative efficacy of individual preparations of botulinum toxin A.Trial registrationPROSPERO: CRD4201200337

The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II

“…According to the FDA Guidance to Industry, assessment scales should also be ordinal, static, reproducible, and include only a limited number of distinct and clinically meaningful categories, preferably with a photonumeric guide for patients and investigators 110 . Common assessment tools such as the facial wrinkle scale and GL severity score are 4‐point photonumeric ordinal scales that ranging from no wrinkling to severe wrinkling and have shown good inter‐ and intraobserver reproducibility 111,112 . The 5‐point photonumeric scale developed by Caruthers and Carruthers is a good example.…”

Clinical Response to IncobotulinumtoxinA, after Demonstrated Loss of Clinical Response to OnabotulinumtoxinA and RimabotulininumtoxinB in a Patient with Musician's Dystonia

“…Recent meta‐analyses show no difference in potencies between onabotulinumtoxinA and incoboutlinumtoxinA . More studies are necessary to determine clinically relevant differences in biological activity and potency of the different toxin types . EMG showing lack of denervation to confirm the case as a true resistance would have been useful.…”

Botulinum Toxin in Pediatric Neurology

“…Each formulation is purported to have unique benefits; however, it is unclear if these differences are clinically significant. 12 …”