Low-Dose BTX-B for Hyperhidrosis (Toxins2002)

Subject: Low-Dose BTX-B for Hyperhidrosis (Toxins2002)

Date: 6/28/2002

E-MOVE reports from the International Conference 2002: Basic and Therapeutic Aspects of Botulinum and Tetanus Toxins. Poster (P) and page (R) numbers are from Naunyn Schmiederberg's Archives of Pharmacology 2002;365(supplement 2).

1. A systematic analysis of dose-related local anhidrotic effects of botulinum toxin type B injections as measured by sudometry
M Winterholler, G Eisenbarth, F Ergbuth, F Birklein
P158, R48

BTX-B causes prolonged anhidrosis at low doses, according to this study.

Fifteen healthy volunteers received subcutaneous injections of MYOBLOC (2-1000 U) into the lower leg over an area of two square centimeters. Sweat tests were performed at baseline, 3 weeks, and 3 months post-injection. Sweating was quantified by starch-iodine staining and quantitative sudomotor axon reflex test (QSART).

Anhidrosis was visible from doses as low as 15 U, and the area of anhidrosis was dose-dependent: 300 U affected an area of approximately 300 square cm, and 1000 U an area of approximately 50 square cm. QSART was completely suppressed by doses of 32.25 U or more, and doses greater than 125 U gave at least 60% suppression for at least 3 months.

The authors conclude, "Compared with the equivalent motor endplate blocking dose previously reported by our group for [Dysport], BoNT/B seems to be more effective in inhibiting sweat production." From the podium, Dr. Winterholler indicated that the Dysport:MYOBLOC ratio of 1:20 for muscle chemodenervation might be tenfold too high for anhidrosis, and that a 1:2 ratio might be more appropriate.

2. Botulinum toxin type B for the treatment of axillary hyperhidrosis
M Wittstock, F Adib Saberi, R Benecke, D Dressler
P159; R48

BTX-B is effective for axillary hyperhidrosis at low doses, according to this study.

Nine patients with hyperhidrosis received 100 U BOTOX to one axilla and either 2000 or 4000 U MYOBLOC to the other. Patients were blinded to the agent and dose used in each axilla.

Mean time to first recurrence of hyperhidrosis was 16-17 weeks for all treatments, with no significant differences for A vs. B or low-dose vs. high-dose B. Patients reported more discomfort from application of BTX-B. Onset was significantly earlier for both high- and low-dose B than for A. One high-dose patient reported dry mouth and eyes and accommodation difficulty.

The authors conclude, "BT-B is a safe and efficient treatment of axillar hyperhidrosis." They suggest that the effectiveness of the low dose indicates a BOTOX:MYOBLOC conversion factor of 1:20 in this condition, noting "the autonomic nervous system seems to be relatively more sensitive to BT-B than to BT-A as compared to the motor system."
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2002 E-MOVE conference reports are made possible in part through unrestricted educational grants from Elan Pharmaceuticals, GlaxoSmithKline, and Pharmacia Corporation.

E-MOVE Editor: Richard Robinson, NASW, WE MOVE