PROMOTION
Table 2. Time to onset of effects for Dysport® and BOTOX® in a frontalis model treatment
Onset of Effect Rating
Maximum Baseline Elevation
Initial Full
Complete
20% 33% 66%
12
24 72
48 72
120 Data based on reference12. Minimum decrease in Dysport®
Time to effect onset (median, hours) BOTOX®
Many clinicians reported anecdotally that many of their patients felt they were seeing (and feeling) an effect a few hours after injection. More data remarkable are now available. Mark
Nestor and Glynis Ablon, based in the US, have recently provided a head-to-head comparison of BOTOX® and Dysport®, which looked at the time of action onset after injection to the frontalis12
. Five injection points
treatment of glabellar lines, which looked at what happened before 7 days10
appeared from the US trials of Dysport® for the .
The results clearly showed that 50% of patients were
responding 2.5 days after injection. This effect was repeated for up to five cycles of treatment in the study. These data were unique at the time and came from a large study with 1200 patients. Similar data appeared for BOTOX® in 201111
, indicating that this very important
aspect of treatment had not been systematically studied previously for that product either. But this remarkable finding, against all the old beliefs
of how BoNT worked, served to encourage interest in finding out what the real time for onset of action was.
Did not meet
10.1% 4.5%
Did the treatment meet your expectations?
I did not have any
1.2% 1.3%
Month 4 (n=485) Week 3 (n=533)
No answer
0% 0.8%
were used, one product on each side of the patient’s forehead, and effects measured on a 4-point Frontalis Rating Scale. For the comparison in 20 patients, 25 units of Dysport® were injected (5 units per injection point) and 10 units of BOTOX® (2 units per injection point). Their findings are summarised in Table 1. Overall, an initial onset for Dysport® was found in 12 hours, but took 48 hours for BOTOX®. The differences were highly significant and showed, for the first time, a clear difference in onset of action between the two main BoNT-A products. But why would such a difference occur? After all, the
active component is the same in both products, BoNT-A neurotoxin. We have no answer yet from BoNT science; any potential reason would be speculation, but the difference seems real.
Patient satisfaction Measuring onset of action is one way to determine one aspect of patient satisfaction indirectly. Alternatively, determining patient satisfaction directly, through the use of appropriate questions before, during and after treatment is always necessary to obtain the best data. Patient satisfaction data for the use of aesthetic BoNT
have been available for some years, either in dedicated publications13–15
main clinical studies and summaries16–19
comprehensive reviews of studies for patient satisfaction are also available20, 21
studies in which large patient populations have been investigated in detail as part of normal clinical practice22
or, more often, as data incorporated into . At least two
. Of particular importance are those .
Real-world data, especially those indicating the frequency that patients actually return for re-treatment, are very important for clinical assessment of patient satisfaction (every 6 months is usual)22
Met 66% 75%
of these studies are significantly deficient in the work carried out and have been subsequently criticised23
. However, some .
Surpassed 22.7% 18.4%
Regrettably, and as might be expected, companies using these deficient studies — often sponsored by them — to support their product, never supply the full, follow-up commentaries that are so vital for clinicians to be fully informed about such data in a balanced way. One new and very recently completed patient
0% 20% 40% 60% 80% 100%
Figure 2 Results of the Galderma ANGEL study for patient satisfaction with AZZALURE® used for the treatment of glabellar lines. © 2012 Galderma. Reproduced with permission
90 ❚ March 2012 |
prime-journal.com
“Measuring onset of action is one way to determine one aspect of
patient satisfaction indirectly. ”
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