A Non-inferiority Clinical Trial to Compare Efficacy and Safety of Abobotulinumtoxin A (Espad Pharmed) Versus AbobotulinumtoxinA (Dysport®, Ipsen Co.) for Correction of Moderate to Severe Glabellar Lines

The aim of this study is to evaluate the efficacy and safety of AbobotulinumtoxinA (produced by Espad Pharmed Darou Co.) for correction of moderate to severe glabellar lines.

Hypothesis: AbobotulinumtoxinA (produced by Espad Pharmed Darou Co.) has acceptable efficacy and safety profile for correction of moderate to severe glabellar lines.

Primary Outcome: To verify the non-inferiority of the efficacy of AbobotulinumtoxinA (produced by Espad Pharmed Darou Co.) compared with AbobotulinumtoxinA (Dysport®, produced by Ipsen Co.) by percentage of responders at maximum frown at day 30 after treatment.

Researchers will compare the efficacy and safety profile of AbobotulinumtoxinA (produced by Espad Pharmed Darou Co.) with AbobotulinumtoxinA (Dysport®, produced by Ipsen Co.).

The study is designed as phase III, randomized, two armed, double-blind, parallel, active controlled, non-inferiority clinical trial.

Participants received a total dose of 40-60 units into 3 to 5 sites. After two weeks, a touch-up intervention could be done based on physician's assessment.


Eligibility Criteria:
Inclusion Criteria:

1. Male or female ≥18 to ≤65 years of age
2. Willingness for signing and having signed the informed consent form
3. Moderate to severe glabellar wrinkle at maximum frown based on glabellar lines severity scale (GLSS)
4. be able to participate in the visit schedules and the study procedures.

Exclusion Criteria:

1. Hypersensitivity to botulinum toxin or any other component of the formulation, as well as to injectable fillers in the facial region.
2. Previous treatment with botulinum toxin in facial areas within the past 6 months.
3. Previous treatment with dermal fillers, dermabrasion, or photo rejuvenation in the glabellar region within the past 12 months.
4. History of dermal filler injection in the forehead region within the past year.
5. History of eyebrow tattooing or any other procedure involving the eyebrow area within the past month.
6. Use of aminoglycosides, penicillamine, quinine, chloroquine, hydroxychloroquine, or calcium channel blockers within the past week.
7. Use of anticoagulants or aspirin within the past 10 days (participants are not required to discontinue their anticoagulant therapy to be enrolled in the study).
8. History of any cosmetic surgery (e.g., filler injections, chemical peels, or laser treatments) or use of products that induce skin remodeling or significantly affect the forehead area or its surroundings, including any aesthetic procedure involving the glabellar lines within the past 6 months.
9. History of any surgical procedure involving facial muscles or scarring in the forehead or surrounding areas (including the eyebrows).
10. Any planned aesthetic procedure involving the upper face during the course of the study.
11. Presence of disorders that may affect neuromuscular function (e.g., myasthenia gravis, amyotrophic lateral sclerosis \[ALS\], or Eaton-Lambert syndrome).
12. History of facial nerve paralysis.
13. Presence of clearly visible and defined facial asymmetry.
14. Ptosis of the eyelids or eyebrows due to facial muscle paralysis or a history thereof.
15. Presence of any active infection or acute dermatological condition in the injection areas.
16. Pregnancy (confirmed by urine test) or lactation.
17. Participation in other clinical studies within 30 days prior to randomization or intention to participate in other clinical trials.
18. Any other condition or circumstance that may pose a risk to the participant or interfere with the satisfactory completion of the clinical outcome.
19. History of participation in other clinical trials involving botulinum neurotoxin products or fillers within the past 6 months.