Clinical differences between botulinum neurotoxin type A and B

Bentivoglio, Anna Rita; Grande, Alessandra Del; Petracca, Martina; Ialongo, Tàmara; Ricciardi, Lucia

doi:10.1016/j.toxicon.2015.08.001

Cited by 68 publications

(66 citation statements)

References 93 publications

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“…Myobloc/Neurobloc was approved by the FDA in 2000 for the treatment of patients who had become immune to BoNT/A1 (Brin et al, 1999), because the two serotypes are immunologically distinct (Atassi, 2004). However, larger doses of BoNT/B1 are required to achieve a comparable therapeutic effect (Botox/Neurobloc dose ratio 1:40–50), and its duration is shorter with respect to that of BoNT/A1 at skeletal muscles, but not at the autonomic nervous system where efficacy of the two neurotoxins is comparable with a dose ratio of 1:25–30/A1:B1 (Bentivoglio et al, 2015). As mentioned above (section II.A), recent data on receptor binding have shown that human synaptotagmin II does not have high affinity for BoNT/B1 owing to a single amino acid substitution in the toxin binding site (Strotmeier et al, 2012).…”

Section: Pharmacologymentioning

confidence: 99%

“…These doses can vary considerably as the recommended range has to be adjusted depending on the individual patient’s features and sensitivity to the toxin. BoNT/A1 is the preferred treatment, whereas BoNT/B1 is recommended for A-resistant patients, because injections are generally more painful, possibly owing to the acidic pH of its solution, efficacy is shorter and immunogenicity higher (Bentivoglio et al, 2015). …”

Section: Pharmacologymentioning

confidence: 99%

“…The use of BoNT within the broad category of autonomic indications includes hypersecretory disorders, such as hyperhidrosis, sialorrhea, and chronic rhinorrhea, and smooth muscle hyperactivities in urologic and gastrointestinal disorders. Owing to an apparently higher affinity for cholinergic autonomic nerve endings, BoNT/B1 is as efficacious as BoNT/A1 in the therapy of secretory disorders both in terms of extent of inhibition and duration of the beneficial effects and at lower relative doses than those required in skeletal muscles (Bentivoglio et al, 2015). …”

Section: Pharmacologymentioning

confidence: 99%

“…A formalized assessment of the American Academy of Neurology confirmed that BoNT therapy is safe and effective for axillary hyperhidrosis (Naumann et al, 2013b); total doses per axilla of 50–100 U Botox or Xeomin, 100–200 U Dysport or 2500 U NeuroBloc/Myobloc may be used (Bentivoglio et al, 2015). …”

Section: Pharmacologymentioning

confidence: 99%

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Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology

et al. 2017

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The study of botulinum neurotoxins (BoNT) is rapidly progressing in many aspects. Novel BoNTs are being discovered owing to next generation sequencing, but their biologic and pharmacological properties remain largely unknown. The molecular structure of the large protein complexes that the toxin forms with accessory proteins, which are included in some BoNT type A1 and B1 pharmacological preparations, have been determined. By far the largest effort has been dedicated to the testing and validation of BoNTs as therapeutic agents in an ever increasing number of applications, including pain therapy. BoNT type A1 has been also exploited in a variety of cosmetic treatments, alone or in combination with other agents, and this specific market has reached the size of the one dedicated to the treatment of medical syndromes. The pharmacological properties and mode of action of BoNTs have shed light on general principles of neuronal transport and protein-protein interactions and are stimulating basic science studies. Moreover, the wide array of BoNTs discovered and to be discovered and the production of recombinant BoNTs endowed with specific properties suggest novel uses in therapeutics with increasing disease/symptom specifity. These recent developments are reviewed here to provide an updated picture of the biologic mechanism of action of BoNTs, of their increasing use in pharmacology and in cosmetics, and of their toxicology.

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Section: Pharmacologymentioning

confidence: 99%

Section: Pharmacologymentioning

confidence: 99%

Section: Pharmacologymentioning

confidence: 99%

Section: Pharmacologymentioning

confidence: 99%

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Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology

et al. 2017

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“…Though BoNT-B is as clinically effective as BoNT-A, BoNT-A is more widely used in management of pain and spasticity. That is possible due to more side effects and shorter more efficacy after BoNT-B injection [15]. The related literature review on this issue revealed no severe adverse events among all studies [13].…”

Section: Knee Osteoarthritismentioning

confidence: 84%

Therapeutic Effects of Intra-articular Botulinum Toxin Type A in Knee Osteoarthritis

Lin¹,

Chou²

2016

J Arthritis

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Knee OsteoarthritisKnee osteoarthritis (KOA) is an intractable and devastating consequence of degeneration that results in tremendous impact on daily activities. Painful disabling KOA occurs in more than 10% of people who are over 55 years old. Those who are severely disabled account for up to 25% of aging people and KOA is a major cause of total knee replacement [1][2][3]. Current osteoarthritis therapies largely rely on rest, weight loss, bracing and assistive devices, physical modalities, therapeutic exercises, and pharmacological interventions [4] which are unsatisfactory for the majority of severe disabled patients, who are left with ambulation deficit despite vigorous treatment intervention. Although numerous patients can be treated with surgery, some of them are not good candidates due to multiple co-morbidities. For these reasons, intra-articular (IA) treatments that reduce chronic joint pain and improve function is the long-term effective and safe alternative options. In a number of recent studies, pain intensity and functional performance resulted from osteoarthritis has been improved after IA injection of botulinum toxin type A (BoNT-A).The Botulinum neurotoxin has been comprehensively studied for its muscle-paralyzing effect by proteolysis of membrane-associated proteins inhibiting of the exocytotic release of acetylcholine, thereby blocking neurotransmission from motor nerve terminals. However, as the growing body of research has demonstrated, IA BoNT-A injection applied to the painful joints can successfully improve symptoms and function by anti-nociceptive effect [5][6][7][8][9]. The mechanism of pain modulation after IA BoNT-A injection by means of two very different strategies by direct inhibition of nociceptive neuropeptides release such as substance P, calcitonin gene related peptide (cGRP), glutamate and the expression of the transient receptor potential vanilloid 1 at the primary sensory fibers, leading to a reduction of peripheral sensitization; by indirect inhibition of central sensitization associated with neuropathic pain through the reduction of the se and blocked of substance P and cGRP secretion within central nerve system [10][11][12].The role of botulinum toxin type A in the clinical management is now considered as part of an established option for chronic advanced arthritis or osteoarthritis if a patient has been refractory to conservative treatments, failed to corticosteroid or hyaluronic acid IA injection and unable to undergo joint surgical intervention. As compared with conventional therapy, IA BoNT-A injection has significant therapeutic effect on pain processing and functional recovery [13]. The pilot study provides evidence that BoNT-A compared to IA corticosteroid achieves a significant and persistent pain modulating effect [6]. The following study further confirmed that the IA BoNT-A compared to education only yielded favorable outcomes that were of considerable longevity, at least 6-month period [14]. Another study demonstrates that IA BoNT-A in patients with chronic pain...

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Safety and Efficacy of RimabotulinumtoxinB for Treatment of Sialorrhea in Adults

et al. 2020

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; for the MYSTICOL Study Group IMPORTANCE RimabotulinumtoxinB (RIMA) may be preferable as an anti-sialorrhea treatment compared with current oral anticholinergic drugs in people with neurological disorders. OBJECTIVE To assess the safety, efficacy, and tolerability of RIMA injections for the treatment of sialorrhea in adults. DESIGN, SETTING, AND PARTICIPANTS This randomized, parallel, double-blind, placebo-controlled clinical trial of RIMA 2500 U and 3500 U was conducted from November 14, 2013, to January 23, 2017. A total of 249 adult patients with troublesome sialorrhea secondary to any disorder or cause were screened. Of them, 13 refused further participation in the study or were lost to follow-up and 49 did not fulfill the criteria for participation; 187 were ultimately enrolled. Patients had to have a minimum unstimulated salivary flow rate (USFR) of 0.2 g/min and a minimum Drooling Frequency and Severity Scale score of 4. EXPOSURES Patients were randomized 1:1:1 to RIMA, 2500 U (n = 63); RIMA, 3500 U (n = 64); or placebo (n = 60). MAIN OUTCOMES AND MEASURES Primary outcomes were the change in USFR from baseline to week 4 and the Clinical Global Impression of Change (CGI-C) at week 4. The CGI-C scores were recorded on a 7-point scale ranging from very much improved to very much worse. Adverse events were recorded throughout the trial period. RESULTS Of 187 patients enrolled (147 men [78.6%]; mean [SD] age, 63.9 [13.3] years), 122 patients had Parkinson disease (65.2%), 13 (7.0%) were stroke survivors, 12 had amyotrophic lateral sclerosis (6.4%), 6 had medication-induced sialorrhea (3.2%), 4 had adult cerebral palsy (2.1%), and 30 had sialorrhea owing to other causes (16.0%). A total of 176 completed the study. Treatment with both doses of RIMA significantly reduced USFR at week 4 vs placebo (mean treatment difference, −0.30 g/min [95% CI, −0.39 to −0.21] for both doses vs placebo, P < .001). The CGI-C scores were statistically significantly improved at week 4 for both treatment groups vs placebo (−1.21 [95% CI, −1.56 to −0.87] for 2500 U, −1.14 [95% CI, −1.49 to −0.80] for 3500 U, both P < .001). Treatment benefits were seen as early as 1 week after injection and were maintained over the treatment cycle of approximately 13 weeks. The RIMA injections were well tolerated compared with placebo. The most common adverse events were self-limited mild to moderate dry mouth, dysphagia, and dental caries. CONCLUSIONS AND RELEVANCE Treatment with RIMA (2500 U and 3500 U) in adults was well tolerated and reduced sialorrhea, with the onset of the effect at 1 week after the injection. These data support the clinical use of RIMA in the management of sialorrhea in adults.

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Clinical differences between botulinum neurotoxin type A and B

Cited by 68 publications

References 93 publications

Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology

Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology

Therapeutic Effects of Intra-articular Botulinum Toxin Type A in Knee Osteoarthritis

Safety and Efficacy of RimabotulinumtoxinB for Treatment of Sialorrhea in Adults

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