Study of Abobotulinum Toxin Versus Neubotulinum Toxin Injection For Hemifacial Spasm in Thai Patients (DNHFS)

Study of Abobotulinum Toxin Versus Neubotulinum Toxin Injection For Hemifacial Spasm in Thai Patients

A 48-Week Prospective, Double-Blinded, Randomized, Cross-over Design in Multicenter Study of 100 Unit of Abobotulinum Toxin Type A (Dyspor) Versus 33.33 Unit of Neubotulinum Toxin Type A (Neuronox) Injection For Hemifacial Spasm in Thai Patients

A 48-Week Prospective, Double-Blinded, Randomized, Cross-over design in Multicenter Study of, 100 unit of Abobotulinum Toxin Type A (Dysport) and 33.33 unit of Neubotulinum Toxin Type A (Neuronox) injection for Hemifacial Spasm in patient diagnosed with Hemifacial Spasm according to clinical diagnosis. It was designed to evaluate the efficacy, safety, tolerability, quality of life and the comparesion the improvement after treatment by of Abobotulinum Toxin Type A (Dysport) injection versus Neubotulinum Toxin Type A (Neuronox) Injection.

The primary objective of the study was to evaluate the safety and efficacy of Abobotulinum Toxin Type A (Dysport) injection and Neubotulinum Toxin Type A (Neuronox) Injection for Hemifacial Spasm. The secondary objective of the study was to evaluate the quality of life of Abobotulinum Toxin Type A (Dysport) and Neubotulinum Toxin Type A (Neuronox) Injection for Hemifacial Spasm. 120 patients diagnosed with Hemifacial Spasm were planned to be enrolled into the study. Total of 120 patients planed to be and randomized. Efficacy criteria: Primary efficacy variable: Comparesion of pre- and post- treatment after 12 and 24 week scale with 33.33 unit of Neubotulinum Toxin Type A (Neuronox) and 100 unit of Abobotulinum Toxin Type A (Dysport); as following 24 hours HFS diary record for 12 week after treatment Time to peak improvement, response duration period, Total intensity score per day, duration of facial muscle spasm (hour per day) and duration of functional impairment (hour per day) record for 12 week after each treatment will be assessed Hemifacial Spasm- 30 Questionnaire (Thai version). Seven subscales (30 items). Mobility (5 items), activity of daily living (5 items) and communication (3 items) are classified as physical health domain. Emotional well-being (7 items), stigma (4 items), social support (3 items) and cognition (3 items) are classified as mental health domain Abnormal involuntary movement scale (AIMS) (Thai version) Rating sacle of the severity of movements in 7 regions, each on a 5 points scale and a separate rating of the overall severity of the abnormal movements, judged on the amplitude of movements, incapacitation postures and positions, including sitting in chair, opening the mouth, tapping the thumb against each finger, holding the hand out stretched and standing and walking, are included. Dental status is also rated, as the presence or absence of problems with teeth or dentures. Secondary efficacy variables: : Comparesion of pre- and post- treatment after 12 and 24 week scale with 50 unit of Neubotulinum Toxin Type A (Neuronox) and 250 unit of Abobotulinum Toxin Type A (Dysport); as following 36-item questionnaire and comprises eight domains: Physical functioning (PF), Role limitations due to physical health (RP), Role limitations due to emotional problems(RE), Vitality (VT), Mental health (MH), Social functioning (SF), Bodily pain (BP), General health (GH) Center of Epidemiologic study -Depression scale (CES-D) Patient health Questionnaire - 9 item (PHQ-9) The investigator's /patient's global assessment of change (GAC) Safety criteria: The assessment of safety and tolerability were based mainly on the frequency of adverse events.

A 48-Week Prospective, Double-Blinded, Randomized, Cross-over design in Multicenter Study of 100 unit of Abobotulinum Toxin Type A (Dysport) versus 33.33 unit of Neubotulinum Toxin Type A (Neuronox) Injection For Hemifacial Spasm in Thai Patients

Abobotulinum Toxin Type A (Dysport) dose was investigated: dose: 100 units ( various units each site depend on clinical )

Neubotulinum Toxin Type A (Neuronox) dose was investigated: dose: 33.33 units ( various units each site depend on clinical )

severity and duration calculated score from patient diary range between 0-6048 higher score mean worse

duration of functional impairment calculated score from patient diary outcome measure as hour per 12 week

Seven subscales (30 items). Mobility (5 items), activity of daily living (5 items) and communication (3 items) are classified as physical health domain. Emotional well-being (7 items), stigma (4 items), social support (3 items) and cognition (3 items) are classified as mental health domain higher score represent worse ( range from 0-120 higher score represent worse)

Rating sacle of the severity of movements in 7 regions, each on a 5 points scale and a separate rating of the overall severity of the abnormal movements, judged on the amplitude of movements, incapacitation postures and positions, including sitting in chair, opening the mouth, tapping the thumb against each finger, holding the hand out stretched and standing and walking, are included. Dental status is also rated, as the presence or absence of problems with teeth or dentures

36-item questionnaire and comprises eight domains: Physical functioning (PF), Role limitations due to physical health (RP), Role limitations due to emotional problems(RE), Vitality (VT), Mental health (MH), Social functioning (SF), Bodily pain (BP), General health (GH) Special calculation of this scale are specified

Inclusion Criteria: The subject has to grant permission to enter into the study by signing and dating the informed consent form before completing any study-related procedure such as any assessment or evaluation not related to the normal medical care of the subject. Able to give written inform consent and retained one copy of the consent form Male or female subject, aged between 20 - 100 years old. Subject diagnosed to be hemifacial spasm. Female subject in good health and sexually active was instructed by the investigator to avoid pregnancy during the study and to use condom or other contraceptive measure if necessary. The subject was required to have a negative urine pregnancy test before being eligible for the study. (At each of the subsequent visit, a urine pregnancy test was performed). Subject judged to be reliable for compliance for taking medication and capable of recording the effects of the medication and motivated in receiving benefits from the treatment. Subject should undergo a normal physical and neurological examination HFS 30, AIMS, SF36, and CES-D, PHQ 9 , and patient diary Exclusion Criteria: The subject was pregnant or lactating. The subject was a female at risk of pregnancy during the study and not taking adequate precautions against pregnancy. The subject had a known hypersensitivity to any of the test materials or related compounds. The subject was unable or unwilling to comply fully with the protocol. The subject received any unlicensed drug within the previous 6 months. Treatment with investigational drug (s) within 6 months before the screening visit. The subject had previously entered in this study. Subject with past history of botulism, other neuromuscular disorder (e.g. myasthenia gravis, Lambert - Elton Syndrome) Subject with significant medical / neurological / psychiatric disorders such as blood dyscrasia, thrombocytopenia, INR>1.2 rheumatoid arthritis, congestive heart failure, coronary artery heart diseases, dementia, psychosis, or other conditions which could influence the clinical trial. Known history of drug abuse (narcotic (s), cafergot, or others) or drug (botulinum toxin type A) allergy. Unable to cooperate fill-up HFS 30, AIMS, SF36, and CES-D Patient who planned to schedule elective surgery during the study. The used of aminoglycoside antibiotics and curare were not allowed during the study.

Kongsengdao S, Kritalukkul S. Quality of life in hemifacial spasm patient after treatment with botulinum toxin A; a 24-week, double-blind, randomized, cross-over comparison of Dysport and Neuronox study. J Med Assoc Thai. 2012 Mar;95 Suppl 3:S48-54.