What is the efficacy of botulinum toxin A (Dysport for the treatment of chronic anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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In a randomized clinical trial, Berkel et al investigated whether botulinum toxin A (Dysport) is more effective than isosorbide dinitrate ointment (ISDN) in the primary treatment of chronic anal fissure. Sixty patients were randomized to receive either ISDN 10 mg/ml (1%) (n = 33) or injection with 60 units of Dysport (n = 27). The primary end-point was the percentage of complete fissure healing after 8 weeks. After a median of 9 weeks, complete fissure healing was noted in 18 of 27 patients in the Dysport group, compared with 11 of 33 patients in the ISDN group (P = 0.010). Absolute improvement of pain scores after 9 weeks was similar between groups. Compared to patients treated with ISDN, patients treated with Dysport had fewer side effects. Of the patients with a healed fissure, 28% of the Dysport group and 50% of the ISDN group had a recurrence within 1 year. In the primary treatment of chronic anal fissure, Dysport is more effective than ISDN ointment and has fewer side effects. [34]

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