Comparison of Two Commercial Preparations of Botulinum Toxin Type A
A Phase iv Controlled Randomized Blinded Study on the Anhydrotic Action Halos and Muscle Activity of Two Commercial Preparations Type a Botulinum Toxin (Dysport® and Botox® ) Administered to the Upper Third of the Face
  • Phase

    Phase 4
  • Study Type

  • Study Participants

The objective of this study is to compare the action halos of the botulinum toxins (Dysport® and Botox®) using two equivalence-ratios and to gather supportive information, such as more detailed data on the effectiveness in reduction of wrinkles and duration of action on the upper part of the face of both products, trough scales and photographs evaluations.
This was a monocentric, prospective, randomized and double-blind study. Fifty nine female patients, presenting with moderate to severe forehead wrinkles, with sweating ability who had never undergone previous BoNT-A injections were enrolled. There were two randomizations, one related to the dose-equivalence (2:1U and 2.5:1U), both reconstituted in the same volume of 0.02 mL per point and another related to the forehead side (left or right) for application of the tested drugs. Baseline, twenty-eight and 112 days later, clinical and photographic assessments, Minor´s test, and electromyographic (EMG) evaluations were performed.
Study Started
May 31
Primary Completion
Nov 30
Study Completion
Dec 31
Results Posted
Aug 17
Last Update
Dec 15


On Visit 1 (Day 0): Botulinum toxin A (Dysport® and Botox®) will be administered according to an equivalence ratio of 2:1. Both reconstituted in the same volume per point, injected in the forehead determined site. Dysport®: 4 units will be injected in the left or right forehead side. Botox® : 2 units will be injected in the left or right forehead side.(opposite side of dysport injection)

  • Other names: BoNT A1 = Dysport, BoNT A2 = Botox

BoNT A1 (4U) Active Comparator

BoNT A1 (4U): Botulinum toxin A (Dysport®)4 units

BoNT-A2 (2U) Active Comparator

BoNT-A2(2U): Botulinum toxin A (Botox®) 2 units


Inclusion Criteria:

Written Informed Consent (Annex 1)
Subjects agreeing to take part in all procedures of the study, including botulinum toxin applications, Minor's test, measurement of Evoked Potentials, photographs, etc.), after being fully informed on the objectives and nature of the investigations
Subjects aged between 18 and 60 years
Subjects presenting with moderate to severe wrinkles on the forehead under maximum voluntary contraction of the m. frontalis

Subjects with positive Minor's test showing sweating on the forehead in standardized conditions described in Annex 2

*The Minor's Test will be the last inclusion criterion to be evaluated. Only these patients eligible according to the other inclusion criteria will undergo the Minor's Test to evaluate their sweating on the forehead. The cut off point is a positive Minor's Test (Level +1) - only subjects with Minor's Test (Level +1) will be recruited in the study (Annex 2).

Medical history and physical examination which, based on the investigator's opinion, do not prevent the patient from taking part in the study and use the products under investigation
Subjects of childbearing age should present a negative urine pregnancy test at baseline and should be using an effective contraceptive method;
Availability of the patient throughout the duration of the study (112 days)
Subject agrees not to undergo other cosmetic or dermatological procedures during the study
Subjects with sufficient schooling and awareness to enable them to cooperate to the degree required by this protocol

Exclusion Criteria:

Pregnant women or women intending to become pregnant in the next 4 months after screening for eligibility
Subjects who are lactating
Subjects having undergone botulinum toxin treatment within the last 6 months
Subjects participating in other clinical trials
Any prior surgery affecting the frontalis and/or orbicularis muscles, prior blepharoplasty or brow lift
Any prior cosmetic procedures, including fillers, or scars that may interfere with the study results
Subjects presenting fronto-parietal alopecia according to the Norwood-Hamilton classification
Subjects with neoplastic, muscular or neurological diseases
Subjects using aminoglycoside and penicillamine antibiotics, quinine and Ca2+ channel blockers
Subjects with inflammation or active infection in the area to be injected
Subjects presenting evident facial asymmetry
Subjects with a history of adverse effects, such as sensitivity to the components of the formula, ptosis or any other adverse effect, which in the investigator's opinion should prevent the patient from participating in the study
Subjects presenting myasthenia gravis, Eaton-Lambert Syndrome and motor neuron diseases
Subjects with coagulation disorders or using anticoagulants
Subjects with known systemic autoimmune diseases
Subjects with a history of medical treatment non-adherence or showing unwillingness to adhere to the study protocol
Any condition that, in the opinion of the investigator, can compromise the evaluation of the study


BoNT A1(4U)


All Events

Event Type Organ System Event Term

Horizontal Action Halo Diameter at 28 Days

Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos.

BoNT A1(4U)

centimeter (Mean)
Standard Deviation: 0.3638


centimeter (Mean)
Standard Deviation: 0.2239

ECMAP in m. Frontialis BoNT A1(4U) X BoNT A2 (2U)

ECMAP(Evoked Compound Muscle Action Potentials) was accessed by an electromyography (EMG) device (TECA Sapphire - TECA Corp., Pleasantville, NY).

BoNT A1(4U)

microvolts (Mean)
Standard Deviation: 319.15


microvolts (Mean)
Standard Deviation: 303.86

Horizontal Action Halo Diameter at 112 Days

Minor's test permits the visualization of the effect of botulinum toxin in the injected area,also called action halos. Mirror is a computer program that allows, through photogrpahs, measuring the horizontal diameter and the area of action halos.

BoNT A1(4U)

centimeter (Mean)
Standard Deviation: 0.3333


centimeter (Mean)
Standard Deviation: 0.2620



Age Continuous

years (Mean)
Standard Deviation: 10.54

Sex: Female, Male

Overall Study

BoNT A1(4U)


Drop/Withdrawal Reasons

BoNT A1(4U)