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The objective of this study is to compare the action halos of the botulinum toxins (Dysport® and Botox®) using two equivalence-ratios and to gather supportive information, such as more detailed data on the effectiveness in reduction of wrinkles and duration of action on the upper part of the face of both products, trough scales and photographs evaluations.
This was a monocentric, prospective, randomized and double-blind study. Fifty nine female patients, presenting with moderate to severe forehead wrinkles, with sweating ability who had never undergone previous BoNT-A injections were enrolled. There were two randomizations, one related to the dose-equivalence (2:1U and 2.5:1U), both reconstituted in the same volume of 0.02 mL per point and another related to the forehead side (left or right) for application of the tested drugs. Baseline, twenty-eight and 112 days later, clinical and photographic assessments, Minor´s test, and electromyographic (EMG) evaluations were performed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BoNT A1 (4U) | Active Comparator | BoNT A1 (4U): Botulinum toxin A (Dysport®)4 units |
|
| BoNT-A2 (2U) | Active Comparator | BoNT-A2(2U): Botulinum toxin A (Botox®) 2 units |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BOTULINUM TOXIN TYPE-A | Drug | On Visit 1 (Day 0): Botulinum toxin A (Dysport® and Botox®) will be administered according to an equivalence ratio of 2:1. Both reconstituted in the same volume per point, injected in the forehead determined site.
|
| Measure | Description | Time Frame |
|---|---|---|
| Horizontal Action Halo Diameter at 28 Days | Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos. | 28 days |
| ECMAP in m. Frontialis BoNT A1(4U) X BoNT A2 (2U) | ECMAP(Evoked Compound Muscle Action Potentials) was accessed by an electromyography (EMG) device (TECA Sapphire - TECA Corp., Pleasantville, NY). | 28 days |
| Horizontal Action Halo Diameter at 112 Days | Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos. | 112 days |
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Inclusion Criteria:
Written Informed Consent (Annex 1)
Female
Subjects agreeing to take part in all procedures of the study, including botulinum toxin applications, Minor's test, measurement of Evoked Potentials, photographs, etc.), after being fully informed on the objectives and nature of the investigations
Subjects aged between 18 and 60 years
Subjects presenting with moderate to severe wrinkles on the forehead under maximum voluntary contraction of the m. frontalis
Subjects with positive Minor's test showing sweating on the forehead in standardized conditions described in Annex 2
*The Minor's Test will be the last inclusion criterion to be evaluated. Only these patients eligible according to the other inclusion criteria will undergo the Minor's Test to evaluate their sweating on the forehead. The cut off point is a positive Minor's Test (Level +1) - only subjects with Minor's Test (Level +1) will be recruited in the study (Annex 2).
Medical history and physical examination which, based on the investigator's opinion, do not prevent the patient from taking part in the study and use the products under investigation
Subjects of childbearing age should present a negative urine pregnancy test at baseline and should be using an effective contraceptive method;
Availability of the patient throughout the duration of the study (112 days)
Subject agrees not to undergo other cosmetic or dermatological procedures during the study
Subjects with sufficient schooling and awareness to enable them to cooperate to the degree required by this protocol
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Doris Hexsel, MD | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brazilian Center for Dermatological Studies | Porto Alegre | Rio Grande do Sul | 90570-040 | Brazil |
13 volunteers were excluded; (screen failure) Iodine allergy=2 Minor´s Test failure=6 Mild wrinkles=3 Inclusion criteria failure=2
Recruitment process: It is planned to recruit a total of 58 subjects at one single centre, Brazilian Center For Studies in Dermatology, in Porto Alegre, Brazil. The anticipated drop out rate is 10%.
Baseline evaluation: May 2005 to July 2007.
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| ID | Title | Description |
|---|---|---|
| FG000 | BoNT A1(4U) | Group 1: Botulinum toxin A (Dysport®) will be administered 4 units of Dysport® |
| FG001 | BoNT-A2(2U) | Group 2: Botulinum toxin A (Botox®) will be administered 2 units of Botox® |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | BoNT A1(4U) | Group 1: Botulinum toxin A (Dysport®) will be administered 4 units of Dysport® |
| BG001 | BoNT-A2(2U) | Group 2: Botulinum toxin A (Botox®) will be administered 2 units of Botox® |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Horizontal Action Halo Diameter at 28 Days | Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos. | The analysis was intention to treat (ITT); One drop out, from baseline to visit 1(intervention) and 3 drop outs from visit 1 to visit 2 (28 days after botulinum toxin injections). Started 59 volunteers - 4 drop outs, there was 55 volunteers in the first analysis. | Posted | Mean | Standard Deviation | centimeter | 28 days |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | BoNT A1(4U) | Group 1: Botulinum toxin A (Dysport®) will be administered 4 units of Dysport® |
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The field of muscular effects of the studied toxins was objectively measured by EMG and it is not very precise. However, there is no more precise objective measurement to currently evaluate the field effects in muscles than EMG.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Débora Zechmeister do Prado | CBED | 55 51 30262633 | cbed@cbed.org.br |
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| ID | Term |
|---|---|
| D019274 | Botulinum Toxins, Type A |
| ID | Term |
|---|---|
| D001905 | Botulinum Toxins |
| D008666 | Metalloendopeptidases |
| D010450 | Endopeptidases |
| D010447 | Peptide Hydrolases |
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|
|
| Withdrawal by Subject |
|
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
Group 2: Botulinum toxin A (Botox®) will be administered 2 units of Botox® |
|
|
|
| Primary | ECMAP in m. Frontialis BoNT A1(4U) X BoNT A2 (2U) | ECMAP(Evoked Compound Muscle Action Potentials) was accessed by an electromyography (EMG) device (TECA Sapphire - TECA Corp., Pleasantville, NY). | Posted | Mean | Standard Deviation | microvolts | 28 days |
|
|
|
|
| Primary | Horizontal Action Halo Diameter at 112 Days | Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos. | Intention to treat analysis. 55 volunteers - One drop out from visit 2 (28 days) to visit 3 (112 days): 54 volunteers. | Posted | Mean | Standard Deviation | centimeter | 112 days |
|
|
|
|
| 0 |
| 26 |
| 0 |
| 26 |
| EG001 | BoNT-A2(2U) | Group 2: Botulinum toxin A (Botox®) will be administered 2 units of Botox® | 0 | 26 | 0 | 26 |
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| D006867 |
| Hydrolases |
| D004798 | Enzymes |
| D045762 | Enzymes and Coenzymes |
| D045726 | Metalloproteases |
| D001426 | Bacterial Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D001427 | Bacterial Toxins |
| D014118 | Toxins, Biological |
| D001685 | Biological Factors |
| 95 |
| No |
| Superiority or Other |