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A Quantitative Analysis of Botulinum Toxin type A (BoNTA) Formulations: A Randomized Double Blind Prospective Clinical Trial of Comparative Dynamic Strain Reduction.
Anthony J. Wilson, MD1, Anthony J. Taglienti, MD1, Brian L. Chang, BS2, Nancy Folsom, RN1, Bianca C. Chin, MD1, Catherine Chang, MD1, Ivona Percec, MD, PhD1.
1Hospital of the University of Pennsylvania, Philadelphia, PA, USA, 2University of Pennsylvania, School of Medicine, Philadelphia, PA, USA.

PURPOSE:
FDA approved formulations of botulinum toxin include (onabotulinumtoxinA) Botox®, (abobotulinumtoxinA) Dysport®, and (incobotulinumtoxinA) Xeomin®. Prior comparative studies have relied upon static photographic wrinkle scales to determine toxin efficacy, without measuring true dynamic outcomes. Here our group uses Digital Image Correlation (DIC) to precisely compare dynamic strain reduction between available neurotoxins.
METHODS:
68 BoNTA-naïve female patients between the ages of 18-75 were recruited. Following baseline imaging of dynamic glabellar furrow, patients were randomized to injection with 20 units of onabotulinumtoxinA, 60 units of abobotulinumtoxinA, or 20 units of incobotulinumtoxinA into the glabella by a single trained injector. Reimaging was conducted 4 and 14 days following injection. Change in average dynamic strain was calculated and compared between groups at all time points via student’s t-test.
RESULTS:
At day 4 post injection, patients receiving onabotulinumtoxinA had a 33.2% decrease in dynamic glabellar compression compared to 28.7% for abobotulinumtoxinA (p = 0.76) and 22.8% for incobotulinumtoxinA (p = 0.5). At day 14 post injection, patients receiving onabotulinumtoxinA had a 62% decrease in strain, compared to 57.6% for abobotulinumtoxinA (p = 0.51) and 51.7% for incobotulinumtoxinA (p = 0.26). At day 4, onabotulinumtoxinA achieved 53% maximal efficacy, compared to 49% and 44% for abobotulinumtoxinA and incobotulinumtoxinA, respectively. There was no correlation between patient age, Glogau or Fitzpatrick scales and strain reduction.
CONCLUSION:OnabotulinumtoxinA, incobotulinumtoxinA, and abobotulinumtoxinA are all effective at glabellar strain reduction. However, within 14 days post injection, there is a strong trend towards superiority of onabotulinumtoxinA in strain reduction efficacy.


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