Dysport Units and Dilution Versus Botox Units and Dilution: 3 to 1 will get it done.
As neurotoxin science continues to advance and more drugs become available, patients will be offered more choices of treatments. Currently Botox (Allergan) and Dysport (Medicis) are the only FDA approved neurotoxins (also called neuromodulators) to treat facial lines and wrinkles. Numerous other similar drugs are currently in the pipeline for FDA approval, including products from China and Germany. Patients outside the USA have more options and US patients will soon have some of these options. More options are not necessarily better options as Botox and Dysport have long track records of safety and efficacy, but these new products will more than likely also offer safety and effectiveness and may also be more cost effective for patients.
All neurotoxins will be compared to Botox in terms of safety, efficacy, time of onset and duration of the effects. As with any new product competitor on the market, positive and negative rumors will abound that can assist or detract from the new product. Finally, all new products will settle in to their niche based solely on their effect and not conjecture.
Dysport has big shoes to fill in taking on Allergan’s previous monopoly of Botox. Dysport has an excellent track record in Europe where it has been an option for a decade. Like any new drug, doctors must figure out “the right way to use it”. More than ever before, drug companies are strapped in getting the word out by Big Pharma regulations. Although regulation is necessary, drug companies are literally hamstrung and sometimes voiceless. Dysport would love to tell doctors the “best way” to use the new drug, but simply are not allowed, so it rests in rumor and conjecture as the means of determining “best practices”.
The biggest question of doctors new to Dysport is “how does the Dysport dosage relate to Botox dosage. Being a consultant for both companies, I am asked this question frequently in my teaching travels around the US. Initially, doctors were saying that “one Botox unit should equal 2.5 Dysport units”. Although not an official comparison, this suggested that in order to have an equal effect, a patient that would normally have 20 units of Botox to treat their frown lines would require 50 units of Dysport to appreciate the same effect. Comparison of units are not “apples to apples” official pharmicopia, but rather convenient conversions to anecdotally arrive at a standard between the two drugs. Unfortunately, I believe that this first round of “units to units” comparison gave Dysport the short end of the stick. Here is the reason. When a new drug is introduced that competes with a standing giant, patients will try it (or not try it) based on numerous factors. These selection factors include the advice of the treating doctor, cost factors, rumored advantages, the “newness” factor and the possibility that the new drug will simply work different or better. Herein lies the catch. If a patient has been getting successful Botox treatments with 20 units to their frown lines and wants to try the new Dysport and their doctor gives the rumored 2.5:1 ratio (50 units of Dysport), the patient is going to be a hard line test of which one works best. In my experience, the 2.5 conversion is not enough Dysport to produce the effect of 20 Botox units. If so, the patient will have a less profound or shorter acting effect and Dysport will be “dissed”. My experience (and that of other surgeons) of using 3 Dysport units for 1 Botox unit seems to be a more accurate dosage in the quest for equipotent treatment between the two drugs. If doctors are truly interested comparing these two drugs, they must use an equipotent dosage, which I believe to be 3 Dysport units for each Botox units or 60 units of Dysport for an area usually treated with 20 units of Botox. Failure to use this ratio may give patients a false comparison of the effects and longevity of Dysport.
Why is all of this important? Personally, I feel that Allergan and Medicis are both great companies and I use fillers and neurotoxins from both of them. From a doctor standpoint, you have to offer all contemporary options to your patients and from a consumer standpoint, every Coke needs a Pepsi. What is important is that when comparing on new product to another, it is done in a fair way for the surgeon and patient to accurately evaluate. Having said this, I believe the fair and balanced (hey, does that sound familiar?) way to this is to inject 3 Dysport units for where you would use 1 Botox unit. Then the surgeon and patient can fairly evaluate the drugs. It is unfair for the company and patients to compare with a lesser amount. You will never find an official chart that says use 3:1 and Medicis is not allowed to even think that out loud, so it is up to the experience of scientifically minded clinicians to fairly sort this out for everyone else. I am trying to do my part and I think it is 3:1 ad nauseum. To prepare Dysport for this dilution, 3 cc of preserved saline is added to the 300 unit Dysport vial. Five syringes are drawn up and each will contain 0.6 cc or 60 units.
To find out more about Botox, Dysport and cosmetic facial surgery in Richmond, Virginia visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery
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