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Clinical Experience of Dose Conversion Ratios Between 2 Botulinum Toxin Products in the Treatment of Cervical Dystonia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
2012 (English)In: Clinical neuropharmacology, ISSN 0362-5664, E-ISSN 1537-162X, Vol. 35, no 6, 278-282 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

The units of different botulinum toxin products are not identical, and the dose equivalence has been debated for several years. In the year 2000, our clinic changed the recommended botulinum toxin product from Botox to Dysport for the treatment of cervical dystonia. Based on published reports, where dose conversion ratios from 1:1 to 1:6 (Botox:Dysport) had been used, and our own clinical experience, the dose conversion ratio was set to 1:2. The objective of this study was to retrospectively monitor the used doses of each product and the subsequent clinical effect.

METHODS:

A retrospective study, using casebook notes from 75 patients, was done to investigate treatment doses, subjective clinical effect, and the appearance of adverse events.

RESULTS:

The median dose conversion ratio that had been used at the product switch was 1:2.3 (Botox:Dysport). After clinical adjustment, the ratio was 1:2.1 at the next 3 treatments. There was a tendency for a more effective treatment and more adverse events after the product switch. A follow-up was performed 6.5 years later using casebook notes from 53 of the same patients. By this time, the doses had been reduced, and the median dose conversion ratio had decreased to 1:1.7 (Botox:Dysport). The adverse events reported at this point were fewer for the patients treated.

CONCLUSIONS:

In this study, the most appropriate dose conversion ratio to use when switching from Botox to Dysport was 1:1.7.

Place, publisher, year, edition, pages
2012. Vol. 35, no 6, 278-282 p.
Keyword [en]
botulinum toxin, Botox, Dysport, cervical dystonia, dose conversion ratio
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-181663DOI: 10.1097/WNF.0b013e3182711fc0ISI: 000311982400005OAI: oai:DiVA.org:uu-181663DiVA: diva2:557304
Available from: 2012-09-27 Created: 2012-09-27 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Botulinum Toxin: Formulation, Concentration and Treatment
Open this publication in new window or tab >>Botulinum Toxin: Formulation, Concentration and Treatment
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Botulinum toxin (BTX) is used in various fields of medicine, including the treatment of hyperhidrosis and cervical dystonia. Botox®, Dysport®, Xeomin® and NeuroBloc® are commercially available BTX products, which are formulated differently and their dosing units are unique. Dosage and concentration of the prepared solution for injection varies considerably among studies comparing the products. Improved guidelines on concentration and dosing when changing from one product to another are warranted. This would ensure the use of the lowest effective doses for good effect, minimal risk of antibody formation and side-effects as well as reduced costs.

The aim of the present work was to find the most appropriate BTX concentration for each of the four products to achieve the highest sweat reducing effect and to investigate dose conversion ratios between Botox and Dysport in the treatment of cervical dystonia when the products are diluted to the same concentration, 100 U/ml.

Paper I and II clearly confirm that it is crucial to consider the BTX concentration in a treatment regimen, especially when changing between different products. The optimal concentration to reduce sweating varies among the products and was found to be 25 U/ml for Botox and Xeomin, approximately 100 U/ml for Dysport and 50 U/ml for NeuroBloc. However, for NeuroBloc the optimal concentration might be even lower.

In Paper III, which is a retrospective study using casebook notes from 75 patients with cervical dystonia, it was found that the most appropriate dose conversion ratio to use when switching from Botox to Dysport was 1:1.7.

In Paper IV, Botox and Dysport were prospectively compared in a double-blind, randomized clinical trial in two different dose conversion ratios (1:3 and 1:1.7) when diluted to the same concentration (100 U/ml). No statistically significant difference was seen between Botox (1:3) and Dysport nor between Botox (1:1.7) and Dysport four weeks after treatment. Some of the secondary outcome observations, however, did indicate that the ratio 1:3 resulted in suboptimal efficacy of Botox but this must be further validated in a larger patient material.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 816
Keyword
Botulinum toxin, Botox, Dysport, Xeomin, NeuroBloc, Hyperhidrosis, Cervical dystonia
National Category
Neurology Dermatology and Venereal Diseases
Research subject
Neurology
Identifiers
urn:nbn:se:uu:diva-181667 (URN)978-91-554-8481-1 (ISBN)
Public defence
2012-11-09, Rudbecksalen, Dag Hammarskjöldsväg 20, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-10-19 Created: 2012-09-27 Last updated: 2013-01-23Bibliographically approved

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Rystedt, AlmaNyholm, Dag

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