Comparison of Prabotulinumtoxin A to Onabotulinumtoxin A in the Treatment of Lateral Canthal Rhytids: A Side-by-Side, Randomized, Double-Blind Comparison

Botulinum toxin type A (Onabotulinumtoxin A, Incobotulinumtoxin A, Abobotulinumtoxin A) has been successfully used in the treatment of lateral canthal rhytid (crow’s feet) reduction. Prabotulinumtoxin A is a newer medication that has been shown to have efficacy for the treatment of upper limb spasticity and improvement in moderate to severe glabellar lines. This study evaluated the onset of action, maximal effect, duration of action, and side effect profile for Prabotulinumtoxin A compared with Onabotulinumtoxin A in the treatment of crow’s feet. A total of 18 subjects aged 25 to 60 without a previous history of neuromuscular disorders, eyelid surgery, or botulinum toxin type A injections were included. Patients received 3 injections of botulinum toxin in the crow’s feet area on each side. Each side received 4U/.1cc of Prabotulinumtoxin A or Onabotulinumtoxin A at each site for a total of 12U/.3cc. The surgeon was masked to the serotype injected. The subjects had their lateral canthal areas photographed in relaxed and smiling positions preoperatively, daily from postinjection days 1 to 4, and weekly thereafter for a total of 12 weeks. Two masked oculoplastic surgeons were given the preoperative photos and postinjection photos and graded them on a scale of 0 to 3 (0 = no wrinkles, 1 = minimal wrinkles, 2 = moderate wrinkles, 3 = significant wrinkles). All subjects tolerated the injections well with no significant side effects or complications. The average onset of action was 3.47 days (1-14) for Onabotulinumtoxin A and 3.81 (1-14) for Prabotulinumtoxin A. The average time to peak effect was 11.11 days (1-56) for Onabotulinumtoxin A and 9.58 days (2-42) for Prabotulinumtoxin A. The average duration of action with improvement compared with baseline crow’s feet was 11.22 weeks (7-12) for Onabotulinumtoxin A and 11.11 weeks (6-12) for Prabotulinumtoxin A. Treatment of crow’s feet lines with Prabotulinumtoxin A achieves a comparable efficacy and safety profile compared with Onabotulinumtoxin A at a 1:1 dose. Therefore, Prabotulinumtoxin A can be used as another option in the treatment of crow’s feet.