Current Evidence on the Unit Equivalence of Different Botulinum Neurotoxin A Formulations and Recommendations for Clinical Practice in Dermatology

Karsai, Syrus; Raulin, Christian

doi:10.1111/j.1524-4725.2008.34375.x

Cited by 47 publications

(15 citation statements)

References 45 publications

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“…Karsai and Raulin were not content with the level of evidence for their findings, and recommended further investigation of lower dose ratios. 36 However, the findings from more recent studies are consistent with those of Karsai and Raulin. 15,16,31,37,38 A study using a human abdomen, in which subjects received ABO and ONA injections at varying dose ratios into the abdomen, found that dose equivalence could be established at a ratio of 1.9:1.0.…”

Section: Definitionssupporting

confidence: 80%

“…Based on their systematic review of the literature in 2009, Karsai and Raulin 36 suggested that dose equivalences of 2.5 units ABO to 1.0 unit ONA should be used, and that in some circumstances this ratio might be reduced to 2:1. Karsai and Raulin were not content with the level of evidence for their findings, and recommended further investigation of lower dose ratios.…”

Section: Definitionsmentioning

confidence: 99%

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Key Parameters for the Use of AbobotulinumtoxinA in Aesthetics: Onset and Duration

Nestor

Ablon

Pickett

2017

Aesthetic Surgery Journal

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Time to onset of response and duration of response are key measures of botulinum toxin efficacy that have a considerable influence on patient satisfaction with aesthetic treatment. However, there is no overall accepted definition of efficacy for aesthetic uses of botulinumtoxinA (BoNT-A). Mechanical methods of assessment do not lend themselves to clinical practice and clinicians rely instead on assessment scales such as the Frontalis Activity Measurement Standard, Frontalis Rating Scale, Wrinkle Severity Scale, and Subject Global Assessment Scale, but not all of these have been fully validated. Onset of activity is typically seen within 5 days of injection, but has also been recorded within 12 hours with abobotulinumtoxinA. Duration of effect is more variable, and is influenced by parameters such as muscle mass (including the effects of age and sex) and type of product used. Even when larger muscles are treated with higher doses of BoNT-A, the duration of effect is still shorter than that for smaller muscles. Muscle injection technique, including dilution of the toxin, the volume of solution injected, and the positioning of the injections, can also have an important influence on onset and duration of activity. Comparison of the efficacy of different forms of BoNT-A must be made with the full understanding that the dosing units are not equivalent. Range of equivalence studies for abobotulinumtoxinA (Azzalure; Ipsen Limited, Slough UK/Galderma, Lausanne CH/Dysport, Ipsen Biopharm Limited, Wrexham UK/Galderma LP, Fort Worth, TX) and onabotulinumtoxinA (Botox; Allergan, Parsippany, NJ) have been conducted, and results indicate that the number of units of abobotulinumtoxinA needs to be approximately twice as high as that of onabotulinumtoxinA to achieve the same effect. An appreciation of the potential influence of all of the parameters that influence onset and duration of activity of BoNT-A, along with a thorough understanding of the anatomy of the face and potency of doses, are essential to tailoring treatment to individual patient needs and expectations.

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Section: Definitionssupporting

confidence: 80%

Section: Definitionsmentioning

confidence: 99%

Key Parameters for the Use of AbobotulinumtoxinA in Aesthetics: Onset and Duration

Nestor

Ablon

Pickett

2017

Aesthetic Surgery Journal

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“…The abobotulinumtoxinA dose of 63 U was higher than the 50 U dose currently recommended for glabellar frown lines 32. Indeed, dose conversion ratios of less than 1:3 (such as 1:2.5) are considered to be more appropriate now 33. The use of a higher concentration in this study may affect the outcome.…”

Section: Discussionmentioning

confidence: 99%

Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study

Rappl

Parvizi

Friedl

et al. 2013

CCID

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BackgroundThree botulinum neurotoxin type A preparations (incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA) are widely approved in Europe and in the US for the treatment of glabellar frown lines. The purpose of this study was to determine and compare the time to onset and duration of treatment effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA for the treatment of glabellar frown lines.Subjects and methodsSubjects aged 20–60 years with moderate to severe glabellar frown lines received one treatment of either 21 units (U) incobotulinumtoxinA, 21 U onabotulinumtoxinA, or 63 U abobotulinumtoxinA. Assessments were made over a period of 180 days. Onset of treatment effect was defined as the day that the observer noted a decrease in glabellar muscle activity compared with baseline photographs and videos. Duration of treatment effect was defined as the time until glabellar muscle action returned to the baseline level. Analyses were performed using a Weibull log(T) regression model.ResultsThe study enrolled 180 subjects; 60 per group. For all three products, onset of treatment effect occurred earlier in female subjects compared to male subjects. For both sexes, a significantly earlier time to onset of treatment effect was seen for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; in female subjects these times were 3.02 days, 5.29 days, and 5.32 days, respectively. The duration of treatment effect was longer for incobotulinumtoxinA compared to onabotulinumtoxinA and abobotulinumtoxinA; for all products, treatment effect duration was longer in females than in males. Time to onset was not a predictor of treatment duration.ConclusionIncobotulinumtoxinA demonstrated a more rapid onset and a longer duration of treatment effect than onabotulinumtoxinA (1:1 dose ratio) and abobotulinumtoxinA (1:3 dose ratio). Onset of effect was faster and duration of effect was longer in female subjects compared to male subjects.

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“…3,7,10 If extrapolating units of onabotulinumtoxinA or incobotulinumtoxinA to abobotulinumtoxinA, a ratio of 1:2.5 is considered appropriate, based on available data and clinical experience. 11,12 The recommended doses within this document refer to incobotulinumtoxinA. The Pan-Asian Aesthetics Toxin Consensus Group considers it reasonable to extend these recommendations with care to other botulinum toxin type A formulations.…”

Section: Overview Of Botulinum Toxin Type a Productsmentioning

confidence: 99%

Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus

Sundaram

Huang

Hsu³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Botulinum toxin type A remains the most popular nonsurgical aesthetic treatment worldwide. Previous consensus statements have focused on Caucasians and on Koreans as generally representative of Asians. However, indications and dosages vary among different ethnic groups. This publication reports the results of a multidisciplinary, pan-Asian consensus focusing on incobotulinumtoxinA.Methods:A consensus group of plastic surgeons and dermatologists from Asia, Europe, and the United States convened for a live meeting in Asia, followed by a questionnaire-based Delphi procedure. Treatment of Asians in both their native countries and countries of migration was discussed.Results:For most items, the group achieved a majority consensus. A number of treatment indications, strategies, and dosages were identified in Asians, which are distinct to those previously described for Caucasians due to differences in facial morphotypes, anatomy, and cultural expectations. The group also formulated position statements for intradermal botulinum toxin type A (“mesotoxin”), body shaping with the calves as a paradigm, and reduction of parotid glands. While Asians have previously been considered a homogeneous group for the purposes of aesthetic treatment, this publication considers regional variations. A new classification of Asian facial morphotypes is proposed to aid treatment planning and implementation.Conclusions:This is the first pan-Asian consensus for aesthetic use of botulinum toxin type A. Its unique objective is to optimize treatment safety and efficacy for patients of complete or part-Asian ancestry in all regions. The recommendations for incobotulinumtoxinA may be extended with care to other botulinum toxin formulations.

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Current Evidence on the Unit Equivalence of Different Botulinum Neurotoxin A Formulations and Recommendations for Clinical Practice in Dermatology

Cited by 47 publications

References 45 publications

Key Parameters for the Use of AbobotulinumtoxinA in Aesthetics: Onset and Duration

Key Parameters for the Use of AbobotulinumtoxinA in Aesthetics: Onset and Duration

Onset and duration of effect of incobotulinumtoxinA, onabotulinumtoxinA, and abobotulinumtoxinA in the treatment of glabellar frown lines: a randomized, double-blind study

Aesthetic Applications of Botulinum Toxin A in Asians: An International, Multidisciplinary, Pan-Asian Consensus

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