This study aims to provide real-world information about the duration, safety, and overall benefit of DaxibotulinumtoxinA (also called DAXI) treatment for adults living with blepharospasm (BSP), a condition that causes uncontrolled blinking or muscle spasms around the eyes, which can interfere with vision and daily activities. Specifically, it is being done to learn more about how well and how long DAXI works for treating adults with blepharospasm.
This is a single-center, open-label, single-arm study, meaning everyone in the study will receive DAXI, and both participants and researchers will know what treatment is being given. The study will include 20 adult participants.
Participants may receive two to three treatment cycles of DAXI injections over about 12 months. The timing between treatments will depend on how long each injection works for each person. Injections will be given at least every 90 days (3 months) but no later than every 180 days (6 months). Participants and their doctors will decide when another injection is needed based on symptom control using a tool called the Blepharospasm Severity Tracker Form (BSTF). To make the injections more comfortable, participants may use topical lidocaine cream, cooling spray, or another local anesthetic before injection.
DAXI will be prepared by the injecting clinician or trained staff right before use. The medication is made by mixing a measured amount of DAXI powder with a small amount of sterile saline solution (salt water) to reach the correct concentration. The exact injection technique (including the dose, location, and number of injection sites) will be chosen by the injector based on each participant's needs, but treatment will only be given in specific facial muscles (corrugator, procerus, orbicularis oculi, and nasalis). The use of imaging tools such as electromyography (EMG) or ultrasound is optional and typically not required for injections around the eyes.
The starting DAXI dose will be based on each participant's current or previous botulinum toxin treatment:
* If the participant was previously treated with onabotulinumtoxinA (Botox®), the same number of "units" will be used for DAXI (a 1:1 conversion). * If the participant was previously treated with incobotulinumtoxinA (Xeomin®), the DAXI dose will be adjusted to about two-thirds of the previous incobotulinumtoxinA dose (a 1.5:1 conversion).
If a participant experienced side effects such as droopy eyelids (ptosis), double vision (diplopia), or dry eyes with prior treatments, that information will help guide dosing decisions. For later injection cycles, the injector may adjust the dose or injection pattern based on how well the participant responds. Whenever possible, the same injector will perform all of a participant's treatments to keep results consistent.
Participants will come to the clinic for in-person visits for most study assessments. After each DAXI injection, the peak effect (best response) will be evaluated about one month later, guided by the BSTF. These visits may be done remotely (via phone or video) when appropriate. The same schedule will be followed for future cycles. For the final treatment, this one-month check will occur unless the participant reports that the treatment's full effect happened sooner.
The main goal (primary endpoint) of the study is to measure how long DAXI's effects last, specifically by tracking the median time until the next injection is needed.
Other key goals (secondary endpoints) include:
* How long participants feel the treatment works * How severe their blepharospasm symptoms are over time * What side effects or safety concerns occur (adverse events)
Adults (18 years of age, or older)
Clinical diagnosis of Blepharospasm that is disruptive enough to warrant ongoing clinical botulinum toxin injections and scoring ≥2 on the BSRS during screening. Blepharospasm may be focal (i.e. Benign essential blepharospasm), associated with non-drug-induced secondary cause (e.g., typical or atypical parkinsonism) or as part of a diagnosis of segmental or generalized dystonia involving the upper cranial region, if blepharospasm is the only indication requiring botulinum toxin injections.
Currently receiving onabotulinumtoxinA or incobotulinumtoxinA for the treatment of blepharospasm with: 1) documented duration of benefit <12 weeks from most recent injection; and 2) no further dose escalation possible or advised due to side effect risk (e.g., ptosis, diplopia, etc.), as determined by treating neurologist; and 3) ability to provide informed consent and comply with study procedures, or subject has a reliable caregiver/proxy.
Written informed consent including authorization to release health information.
Tardive or medication-induced blepharospasm, as well as psychogenic/functional blepharospasm.
Active ocular pathology interfering with evaluation or injection safety.
Neuromuscular junction or motor neuron disorders (e.g., myasthenia gravis, Lambert-Eaton Myasthenic Syndrome, Amyotrophic Lateral Sclerosis, etc.).
Known hypersensitivity to botulinum toxin or formulation components.
Single group
Botulinum Neurotoxin Type A
DrugDaxibotulinumtoxinA (DAXI) for injection is a sterile, lyophilized powder containing 100 units of active daxibotulinumtoxinA per vial, along with inactive ingredients including RTP004, trehalose dihydrate, L-histidine, L-histidine hydrochloride, and polysorbate 20. It is reconstituted with Bacteriostatic Sodium Chloride Injection 0.9% (Pfizer) and stored at 2-8°C. DAXI will be prepared by trained injectors or staff, with all preparations documented. Experienced movement disorder neurologists will administer injections, primarily from UPenn's Parkinson's Disease and Movement Disorders Center. Dosing will follow prior treatment patterns using a 1:1 conversion from onabotulinumtoxinA or 1.5:1 from incobotulinumtoxinA, adjusted for prior adverse effects. Injection sites will be selected based on clinical presentation, with optional EMG or imaging guidance.
First time to retreatment
Time to retreatment (in days) with DAXI between the first and second study injection cycle.
Final time to retreatment
For patients who receive 3 study injection cycles with DAXI over 12 months, a second primary endpoint will be the time to retreatment (in days) between the second-to-last and last injection cycle (i.e., between DAXI cycles 2 and 3).
Difference in time to return of symptoms after first DAXI cycle
Change in time (in days) to return of baseline blepharospasm symptoms, as documented in the Blepharospasm Severity Tracker Form between data relating to the last clinical injection cycle prior to screening and the first DAXI study injection cycle.
Difference in time to return of symptoms after final DAXI cycle
Change in time (in days) to return of baseline BSP symptoms, as documented in the Blepharospasm Severity Tracker Form between data relating to the last clinical injection cycle prior to screening and the last DAXI study injection cycle.
Change in severity after first DAXI injection cycle
Change in the Blepharospasm Severity Rating Scale (BSRS) total score between Visit 2 (peak efficacy assessment of last clinical injection) and Visit 4 (peak efficacy assessment of first DAXI injection). The BSRS is a validated scale with scores ranging from 0 to 18, with higher numbers reflecting worsening blepharospasm severity.
Change in severity after final DAXI injection cycle
Change in Blepharospasm Severity Rating Scale (BSRS) total score between Visit 2 (the peak efficacy assessment of the last clinical injection) and the peak efficacy assessment following the subject's final DAXI study injection (which may occur during either the second or third injection cycle, depending on how long the individual subject chooses to wait before reinjection with DAXI). The BSRS is a validated scale ranging from 0 to 18, with higher scores indicating greater blepharospasm severity.
First change in craniocervical dystonia questionnaire
Change in Craniocervical dystonia questionnaire (CDQ-24) total score between V2 (peak efficacy assessment of last clinical injection) and V4 (peak efficacy assessment of first DAXI injection). The CDQ-24 is a validated scale that tracks patient-reported outcomes, with scores ranging from 0 to 96. Higher scores indicate worsening dystonia symptoms.
Final change in craniocervical questionnaire
Change in Craniocervical dystonia questionnaire (CDQ-24) total score between V2 (peak efficacy assessment of last clinical injection) and the peak efficacy assessment following the subject's final DAXI study injection (which may occur during either the second or third injection cycle, depending on how long the individual subject chooses to wait before reinjection with DAXI). The CDQ-24 is a validated scale that tracks patient-reported outcomes, with scores ranging from 0 to 96. Higher scores indicate worsening dystonia symptoms.
Average total DAXI doses at first and final study cycle
Average total dose in units (with standard deviation) of daxibotulinumtoxinA for each of the different facial muscles injected during the first and last study injection cycle.
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University of Pennsylvania
Lead sponsor
Revance Therapeutics, Inc.
Collaborator
