Treatment of moderate to very severe glabellar lines and lateral canthal lines
Disclosed herein are methods of treatment of moderate to severe and very severe glabellar lines and lateral canthal lines using liquid botulinum neurotoxin compositions. Also disclosed are liquid compositions of botulinum neurotoxin.
1 . A method of treating moderate to severe lateral canthal lines (LCL) in a human subject having LCL, comprising administering to the subject 30 to 75 LD50 units of a RelabotulinumtoxinA by subdermal, transdermal, intradermal, or intramuscular injection of a liquid composition comprising 10 to 200 LD50 units per mL of the RelabotulinumtoxinA, thereby reducing the appearance of moderate to severe LCL, wherein the liquid composition has a pH between 6.0 and 7.5 and further comprises:
(a) sodium chloride (NaCl) at a concentration of 100-300 mM;
(b) potassium chloride (KCl) at a concentration of 1-25 mM;
(c) two to four sources of phosphate ions independently selected from sodium phosphate, potassium phosphate, di-sodium hydrogen phosphate dehydrate, and sodium dihydrogen phosphate dehydrate, wherein each source of phosphate ions is independently at a concentration of 1-50 mM;
(d) at least one amino acid selected from alanine, valine, leucine, isoleucine, methionine, phenylalanine, tyrosine, and tryptophan at a concentration of about 0.75 to about 2.25 mg/mL; and
(e) at least one non-ionic surfactant selected from a polysorbate and a nonoxynol at a concentration of about 0.1% (v/v) to about 1.5% (v/v);
wherein the liquid composition is not reconstitution from a lyophilized or freeze-dried form by a physician prior to administration; and
wherein the LD50 unit value is determined using a gelatine phosphate buffer.
2 . The method of claim 1 , where the liquid composition comprises two sources of phosphate ions.
3 . The method of claim 1 , wherein the amino acid is in the L isoform.
4 . The method of claim 1 , wherein the amino acid is present at a concentration of 0.75 to 2.25 mg/mL and the non-ionic surfactant is present at a concentration of 0.1% (v/v) to 1.5% (v/v).
5 . The method of claim 1 , wherein the pH of the liquid composition is between 6.6 and 6.9.
6 . The method of claim 1 , wherein the RelabotulinumtoxinA has a molecular weight of about 150 kDa.
7 . The method of claim 1 , wherein the osmolality of the liquid composition is between 270 mosm/kg and 310 mosm/kg.
8 . The method of claim 1 , wherein 30, 45, 50, 60, or 75 units of RelabotulinumtoxinA is administered to the subject.
9 . The method of claim 1 , wherein the injection is intramuscular.
10 . The method of claim 1 , wherein the human subject further has moderate to severe glabellar lines (GL).
11 . The method of claim 10 , wherein the subject is injected multiple times in the glabellar region.
12 . The method of claim 11 , wherein adjacent injections are separated by about 0.5 to about 10 cm.
13 . The method of claim 11 , wherein adjacent injections are separated by about 1.5 to about 3 cm.
14 . The method of claim 11 , wherein the injections are in the procerus muscle and the corrugator supercillii muscles on each side of the face.
15 . The method of claim 14 , wherein the injections are first made in the procerus muscle followed by the corrugator supercillii muscles on each side of the face, moving outwards from the median.
16 . The method of claim 11 , wherein all the injections are about 1 cm above the upper orbital rim and internal to the mid-pupillary lines.
17 . The method of claim 11 , wherein all the injections are at least 1 cm above the central eyebrow or the bony supraorbital ridge.
18 . The method of claim 11 , further comprising applying pressure on the upper orbital rim while injecting to minimize risks of regional effect of the botulinum neurotoxin.
19 . The method of claim 1 , wherein the subject is injected multiple times below the lateral canthus, in the external part of the orbicularis oculi, and/or 1-2 cm from the orbital rim.
20 . The method of claim 11 , wherein the subject is further injected multiple times below the lateral canthus, in the external part of the orbicularis oculi, and/or 1-2 cm from the orbital rim.
21 . The method of claim 1 , wherein said method is repeated at intervals from about 1 month to about 6 months.
22 . The method of claim 21 , wherein said method is repeated at intervals from about 3 months to about 6 months.
23 . The method of claim 21 , wherein said method is repeated at intervals of about 4 months.
24 . A method of treating moderate to severe lateral canthal lines (LCL) in a human subject having LCL, comprising administering to the human subject 30 to 75 LD50 units of a RelabotulinumtoxinA by subdermal, transdermal, intradermal, or intramuscular injection of a liquid composition having a pH between 6.0 and 7.5 comprising the RelabotulinumtoxinA and:
(i) 100 to 300 mM of a first buffering agent selected from sodium chloride, potassium chloride, sodium phosphate, potassium phosphate, di-sodium hydrogen phosphate dehydrate, or sodium dihydrogen phosphate dehydrate;
(ii) 1 to 25 mM of a second buffering agent selected from sodium chloride, potassium chloride, sodium phosphate, potassium phosphate, di-sodium hydrogen phosphate dehydrate, or sodium dihydrogen phosphate dehydrate;
(iii) 1 to 25 mM of a third buffering agent selected from sodium chloride, potassium chloride, sodium phosphate, potassium phosphate, di-sodium hydrogen phosphate dehydrate, or sodium dihydrogen phosphate dehydrate;
(iv) 1 to 25 mM of a fourth buffering agent selected from sodium chloride, potassium chloride, sodium phosphate, potassium phosphate, di-sodium hydrogen phosphate dehydrate, or sodium dihydrogen phosphate dehydrate;
(v) 0.1 to 3.0 mg/mL of one or more stabilizers selected from alanine, valine, leucine, serine, threonine, lysine, histidine, tryptophan, aspartic acid, or glutamic acid; and
(vi) 0.05% (v/v) to 2.5% (v/v) of one or more surfactants selected from polysorbates or nonoxynols;
wherein the liquid composition is not reconstitution from a lyophilized or freeze-dried form by a physician prior to administration; and
wherein the LD50 unit value is determined using a gelatine phosphate buffer.
25 . The method of claim 24 , wherein the human subject further has moderate to severe glabellar lines (GL).