Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

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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“…6,16,19,37,43,44 Similar patterns exist for time to maximum effect and are also repeated for different target muscles. 15,16,19 …”

Section: Drug-related Factors Potentially Affecting Onset Of Activitymentioning

confidence: 65%

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

Nestor

Ablon

Pickett

2017

Aesthetic Surgery Journal

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“…Inwieweit Unterschiede zwischen den einzelnen BoNT-Präparaten (abgesehen von der unterschiedlichen Wirkstärke) klinisch relevant sind, kanninsbesondere für die Schmerzindikation -derzeit nicht beurteilt werden. Unterschiede in der Ausbreitung und Verteilung werden diskutiert, sind aber noch nicht abschließend bewertet [19,51]. Die durch die geringe Menge an Fremdeiweißen verursachte seltenere immunologische Reaktion von IncoA wäre vor allem hinsichtlich einer Antikörperent-wicklung bei längerfristigen Repetitivgaben von Interesse.…”

Section: Präparatunclassified

“…Die durch die geringe Menge an Fremdeiweißen verursachte seltenere immunologische Reaktion von IncoA wäre vor allem hinsichtlich einer Antikörperent-wicklung bei längerfristigen Repetitivgaben von Interesse. Aussagekräftige Studien fehlen hierzu allerdings noch [19]. Die langjährige, ständig steigende Anwendung im ästhetischen Bereich lässt allerdings alle eingesetzten Präparate gleichermaßen als sichere und gut verträg-liche Therapeutika erscheinen.…”

Section: Präparatunclassified

Einsatz intra- bzw. subkutaner Botulinumtoxine bei Post-Zoster-Neuralgie

2016

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“…Preventing acetylcholine release affects both the neuromuscular junctions and other types of synapses. Depending on the target tissue, the toxin may block cholinergic innervation of skeletal muscles, but it also may block cholinergic innervation of the exocrine glands [2][3][4]. Since the 1980s, many medical indications of the toxin have emerged.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic uses and efficacy of botulinum toxin in orofacial medicine

Chikhani

Ejeil

2018

J Oral Med Oral Surg

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--Introduction: Botulinum toxin, primarily known for its use in cosmetic surgery, is also used for therapeutic purposes in many medical fields. It works as a muscle relaxant and inhibits glandular secretions. In the orofacial sphere, the use of this toxin is proposed in particular for disabling myofascial pain and aberrant salivary disorders. Methodology: A critical analysis of the literature, based on PUBMED data, concerning the orofacial indications of botulinum toxin was carried out. Results: The literature is abundant regarding the therapeutic interest of this toxin for several oral pathologies, but scientific merits vary markedly from one indication to another. Discussion: The musculorelaxant and antisecretory action of this toxin appears to be demonstrated in the case of bruxism, limitation of the mouth opening and in hypersialorrhea. On the other hand, its medical benefit is still not supported by scientific evidence for masseter hypertrophy, tonicity of the levator labii superioris muscles, sialocele fistulae and Frey's syndrome. Conclusion: Additional high-level studies, unbiased, randomized controlled trials, are required to eliminate the uncertainties that persist about the clinical impact of botulinum toxin and to justify the development of recommendations for good practice valid and credible.

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Pharmaceutical, Biological, and Clinical Properties of Botulinum Neurotoxin Type A Products

Cited by 124 publications

References 74 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

Einsatz intra- bzw. subkutaner Botulinumtoxine bei Post-Zoster-Neuralgie

Therapeutic uses and efficacy of botulinum toxin in orofacial medicine

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