Botox Formulations Differ in Onset, Duration for Frown Lines
A randomized trial showed quantitative differences between four botulinum toxin A formulations among women treated for glabellar rhytids, with abobotulinum toxin A (ABoNT/A) and prabotulinum toxin A (PBoNT/A) having a faster onset of effect than onabotulinum toxin A (OBoNT/A) and incobotulinum toxin A (IBoNT/A), and PBoNT/A showing a significantly greater effect at 3 months.
METHODOLOGY:
In a single-center, double-blind randomized clinical trial, 143 women aged 30-65 years were randomly assigned 1:1:1:1 to OBoNT/A, ABoNT/A, PBoNT/A, or IBoNT/A at standard doses.
Their mean age was 43.5 years; most participants (83.9%) were White, 4.9% were Black, and 4.2% were Asian.
Participants were followed up at days 3, 30, 90, and 180.
The primary outcome was glabellar strain, measured using dynamic three-dimensional photogrammetry. The secondary outcome was patient satisfaction, assessed with FACE-Q surveys.
TAKEAWAY:
Compared with OBoNT/A (48.0%) and IBoNT/A (40.3%), ABoNT/A (67.4%) and PBoNT/A (61.7%) showed a significantly faster onset, with strain reduction observed at day 3 ( P < .05 for all comparisons). PBoNT/A maintained a significantly higher strain reduction (20.5%) than OBoNT/A (0.5%; P = .03) at day 180.
< .05 for all comparisons). PBoNT/A maintained a significantly higher strain reduction (20.5%) than OBoNT/A (0.5%; = .03) at day 180. Maximum treatment efficacy most frequently occurred at day 30, with an overall median efficacy of 88% in the total cohort and no significant difference between the treatments at day 30. Maximum efficacy was 89.3% in the OBoNT/A, 93% in the PBoNT/A, and 89.5% in the IBoNT/A groups.
Increasing baseline glabellar strain severity resulted in proportionally greater improvement with treatment across all formulations.
FACE-Q scores improved significantly from baseline across all groups by day 30, with most improvements lasting through 6 months and no significant differences between treatment groups. No adverse events were reported.
IN PRACTICE:
'This randomized clinical trial demonstrated precise quantitative differences between 4 BoNT/A formulations in treating glabellar strain,' the study authors wrote, adding that the quantification of the effect of BoNT/A 'provides an objective foundation to guide individualized product selection and patient education.'
SOURCE:
The study was led by Mehdi S. Lemdani, BA, University of Pennsylvania, Philadelphia, and was published online on May 28 in JAMA Dermatology .
LIMITATIONS:
Limitations included reduced participant retention at the final visit and inclusion of only female participants. Differential dosing and treatment of adjoining regions were not examined.
DISCLOSURES:
The study was funded by Evolus. Lemdani and three other authors reported receiving grants from Evolus during this study. One author also received personal fees from AbbVie and Galderma.
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Campus notes: June 22, 2025
Teagan Graham, Reading, graduated from the University at Buffalo, N.Y., with a bachelor's degree in health and human services/early childhood education. York College The following area students received degrees from York College of Pennsylvania: Master of education: Julianna Kusy, Kutztown; Isabelle Popoter, Spring Township. Master of science in nursing: Elyse Batson, Exeter Township. Bachelor of arts: Isabella Antos, South Heidelberg Township; Lauryn Johnson, Exeter Township; Isabella Hoeltzel, Leesport; Elizabeth Trumbore, Temple. Bachelor of business administration: Gabriel Trevena, South Heidelberg Township. Bachelor of science: Brett Reinert, Douglassville; Haley Akins, Markus Jeschonnek and Brianna Endy, Exeter Township; Alexander LaVerdure, Oley Township;. Bachelor of science in nursing: Morgan Sauers, Gilbertsville; Taryn Boyer, Temple. Items are supplied by the colleges involved.
