IncobotulinumtoxinA in the Treatment of Upper Facial Lines: Results From Two Randomized, Double-Blind, Placebo-Controlled, Phase III Studies.

backgroundTwo randomized, double-blind, placebo-controlled, Phase III studies of incobotulinumtoxinA for treating upper facial lines (UFLs; ie, a combination of glabellar frown lines [GFLs], horizontal forehead lines [HFLs], and lateral canthal lines [LCLs]) were conducted in the United States (ULTRA I: NCT04594213) and Germany (ULTRA II: NCT04622254).

objectivesThe aim of this study was to evaluate the safety and efficacy of simultaneous intramuscular injections for UFLs. Longer-term safety and efficacy were assessed in open-label extension periods.

methodsHealthy participants (≥18 years) with moderate-to-severe GFLs, HFLs, and symmetric LCLs at maximum contraction on the 5-point Merz Aesthetics Scales were randomized 2:1:1 to receive up to 64 units of incobotulinumtoxinA in the main period for each trial. Treatment groups were: UFLs, GFLs, and HFLs (ULTRA I), LCLs (ULTRA II), and placebo. Primary efficacy endpoints were the proportions of GFL, HFL, and LCL responders, defined as a Merz Aesthetics Scale score for the respective area of 0 (no) or 1 (mild) and a ≥2-grade improvement from baseline to Day 30, as assessed by both investigator and participant.

resultsOverall, 362 and 368 participants received treatment in ULTRA I and ULTRA II, respectively. In both studies, incobotulinumtoxinA treatment was significantly more effective than placebo with respect to the primary endpoints (P < .0001) and key secondary endpoints (P < .0001). The open-label extension period results were consistent with those seen in the main period. No new safety findings were identified.

conclusionsIn ULTRA I and ULTRA II, the safety and efficacy of incobotulinumtoxinA for the simultaneous treatment of moderate-to-severe UFLs were demonstrated, with significant improvements across all primary and secondary endpoints vs placebo. LEVEL OF EVIDENCE: 1 (THERAPEUTIC):