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Original Article Plastic and Aesthetic Research

Patient-centric dose equivalency pilot

study of incobotulinumtoxin a (xeomin)

vs. abobotulinumtoxin a (dysport) in the

treatment of glabellar frown lines

Jonathan Bank , Nicole A. Phillips , Laurie A. Casas 1
2
1
1 Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, IL 60026, USA.
2 Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA.
Address for correspondence: Dr. Laurie A. Casas, Department of Surgery, Section of Plastic and Reconstructive Surgery, University of
Chicago Medical Center, Chicago, IL 60026, USA. E-mail: lcasas@casas.md

ABSTRACT
Aim: Incobotulinumtoxin A (xeomin) has been proposed as an alternative to abobotulinumtoxin
A (dysport) and onabotulinumtoxin A (Botox) in the treatment of glabellar frown lines. A recent
study is comparing abobotulinumtoxin A and onabotulinumtoxin A revealed equivalent efficacy
with a dose conversion ratio of 2.5:1. We sought to establish effectiveness and dosing equivalency
of incobotulinumtoxin A vs. abobotulinumtoxin A. Methods: Inclusion criteria for this pilot study
included patients of a single surgeon (LAC) who had previously received a constant dose of
abobotulinumtoxin A over at least four consecutive treatment sessions for the previous 12 months to
achieve an 85-90% elimination of dynamic glabellar frown lines. The primary outcome sought dose
comparison between established maintenance abobotulinumtoxin A dosing and incobotulinumtoxin
A first-time dosing. A 2:1 conversion (abobotulinumtoxin A: incobotulinumtoxin A) was chosen in
most patients. Secondary outcomes were patient-reported onset of effect, physician-assessed effect
at 10-12 weeks, pain associated with administration, and patient perceived need for re-treatment at
2 weeks. Results: A total of 32 subjects were included. The mean dose of incobotulinumtoxin A was
17.1 units (± 6.1, the median dose 20 units). The mean dose of abobotulinumtoxin A was 27.6 (± 11.7,
the median dose 27.5 units). The mean difference in treatment units was -10.5 (95% confidence
interval, P < 0.001). Among 30 patients who reported effect onset, the median was 8.5 days, with a
range of 1-14. At 10-12 weeks, muscle paralysis was assessed to be 69.2% (± 27.3), vs. 90.3% (± 1.8)
with abobotulinumtoxin A (P < 0.001). The majority of patients rated pain of administration as
equal or greater to that of abobotulinumtoxin A (63% and 22%, respectively). Three patients (9%)
required re-treatment at 2 weeks with abobotulinumtoxin A due to lack of effective treatment with
incobotulinumtoxin A. Abobotulinumtoxin A re-treatment was chosen by the patient. Conclusion: We
found incobotulinumtoxin A at 17.1 (± 6.1) units to be less effective than abobotulinumtoxin A
at 27.6 (± 11.7) units in the treatment of glabellar frown lines at 10-12 weeks postadministration.
Dosing was less predictable than dosing associated with abobotulinumtoxin A treatment. Larger,
randomized controlled trials are indicated
to further delineate these differences and to
Access this article online clarify whether this difference from previously
Quick Response Code: published incobotulinumtoxin A dosing may
Website: have been due to the small sample size.
www.parjournal.net
Key words:
DOI: Abobotulinumtoxin A, glabellar frown lines,
10.4103/2347-9264.149366
incobotulinumtoxin A, rhytids

12 Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015