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    Clinical Trial Results:
    A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study to Evaluate the Safety and Efficacy of MT10109L (NivobotulinumtoxinA) for the Treatment of Glabellar Lines.

    Summary
    EudraCT number
    		 2018-004384-31
    Trial protocol
    		 BE  
    Global end of trial date
    25 Jan 2021

    Results information
    Results version number
    		 v1(current)
    This version publication date
    13 Dec 2023
    First version publication date
    13 Dec 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MT10109L-001
    Additional study identifiers
    ISRCTN number
    		 -
    US NCT number
    		 NCT03795922
    WHO universal trial number (UTN)
    		 -
    Other trial identifiers
    		 IND: 121473
    Sponsors
    Sponsor organisation name
    Medytox Inc
    Sponsor organisation address
    78, Gangni 1-gil, Ochang-eup, Cheongwon-gu, Cheongju-si, Korea, Republic of, 28126
    Public contact
    Young Ryu, Medytox Inc, +82 2-69015424,
    Scientific contact
    Gyungjin Heo, Medytox Inc, +82 2-6901-5839, gjheo@medytox.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    29 Sep 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 Mar 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Jan 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To compare the efficacy between MT10109L and placebo for the treatment of GL in participants with moderate to severe GL. The total global enrollment (as presented in the "Population of Trial Subjects" below was 234, which included the Intent-To-Treat population. However, all primary and secondary efficacy analyses for EU regulatory endpoints reported here are using the mITT population that included a total of 191 participants (USA - 153; Russia - 21 and; Belgium - 17).
    Protection of trial subjects
    The study protocol, all study protocol amendments, written study participant information, informed consent form (ICF), Investigator’s Brochure (IB) and any other relevant documents were reviewed and approved by an independent ethics committee (IEC) or institutional review board (IRB) at each study center. The study was conducted in accordance with the protocol, the ethical principles derived from international guidelines including the Declaration of Helsinki and Council for International Organizations of Medical Sciences International Ethical Guidelines, applicable International Council for Harmonisation (ICH)/Good Clinical Practice (GCP) and other Guidelines, and applicable laws and regulations. An ICF approved by each study center’s IEC/IRB was signed by the participant or their legally authorized representative and the authorized person obtaining the ICF before the participant was entered in the study.
    Background therapy
    		 -
    Evidence for comparator
    		 -
    Actual start date of recruitment
    24 Dec 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Belgium: 26
    Country: Number of subjects enrolled
    United States: 178
    Country: Number of subjects enrolled
    Russian Federation: 30
    Worldwide total number of subjects
    234
    EEA total number of subjects
    26
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    218
    From 65 to 84 years
    16
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    		 Participants were screened and recruited at sites in US, Belgium and Russia. The data described here is for the Intent-to-Treat population. The Intent-to-treat (ITT) population consisted of all randomized participants.

    Pre-assignment
    Screening details
    		 234 met the inclusion/exclusion criteria and were randomized.

    Period 1
    Period 1 title
    Double-blind
    Is this the baseline period?
    		 Yes
    Allocation method
    Randomised - controlled
    Blinding used
    		 Double blind
    Roles blinded
    		 Subject, Investigator
    Blinding implementation details
    Randomization and double-blinding were used to minimize bias arising from the assignment of participants to treatment groups and the expectations of participants, investigators, and individuals collecting data.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    		 Placebo
    Arm description
    		 Placebo was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1.
    Arm type
    		 Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    5 injection sites. 0.1 ml per injection. Placebo - 0 U per 0.1 ml.

    Arm title
    		 MT10109L
    Arm description
    		 MT10109L was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1
    Arm type
    		 Experimental

    Investigational medicinal product name
    MT10109L
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    5 injection sites. 0.1 ml per injection. MT10109L - 4 U per 0.1 ml. Total = 20 U

    Number of subjects in period 1
    		Placebo MT10109L
    Started
    80
    154
    Completed
    71
    138
    Not completed
    9
    16
         Consent withdrawn by subject
    4
    10
         Early termination, COVID, Family issue
    1
    2
         Adverse event, non-fatal
    2
    1
         Pregnancy
    -
    1
         Lost to follow-up
    2
    2
    Period 2
    Period 2 title
    Open-label - Re-treatment 1
    Is this the baseline period?
    		 No
    Allocation method
    Not applicable
    Blinding used
    		 Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    		 MT10109L re-treatment 1 for Placebo arm
    Arm description
    		 In the open-label part, participants in the placebo arm, who met retreatment criteria, were allowed up to 2 MT10109L treatments.
    Arm type
    		 Experimental

    Investigational medicinal product name
    MT10109L
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    2 treatment cycles in the open-label period. 5 injection sites per treatment. 0.1 ml per injection. MT10109L - 4 U per 0.1 ml. Total = 20 U per treatment cycle

    Arm title
    		 MT10109L re-treatment 1 for experimental arm in cycle 1
    Arm description
    		 Participants from the experimental arm of Period 1, who met protocol-defined re-treatment criteria, were eligible to receive up to two additional MT10109L during the open-label part..
    Arm type
    		 Experimental

    Investigational medicinal product name
    MT10109L
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Retreatment cycle in the open-label period. 5 injection sites per treatment. 0.1 ml per injection. MT10109L - 4 U per 0.1 ml. Total = 20 U per treatment cycle

    Number of subjects in period 2 [1]
    		MT10109L re-treatment 1 for Placebo arm MT10109L re-treatment 1 for experimental arm in cycle 1
    Started
    69
    136
    Completed
    65
    129
    Not completed
    4
    7
         Consent withdrawn by subject
    1
    2
         Physician decision
    1
    2
         Early termination, COVID, Family issue
    2
    2
         Lost to follow-up
    -
    1
    Notes
    [1] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Justification - Only participants from the previous treatment period who met a protocol-defined re-treatment criteria entered into the next treatment period.
    Period 3
    Period 3 title
    Open-label - Re-treatment 2
    Is this the baseline period?
    		 No
    Allocation method
    Not applicable
    Blinding used
    		 Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    		 MT10109L re-treatment 2 for Placebo arm
    Arm description
    		 In the open-label part, participants in the placebo arm, who met retreatment criteria, were allowed up to 2 MT10109L treatments.
    Arm type
    		 Experimental

    Investigational medicinal product name
    MT10109L
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Retreatment cycle in the open-label period. 5 injection sites per treatment. 0.1 ml per injection. Placebo - 4 U per 0.1 ml. Total = 20 U per treatment cycle

    Arm title
    		 MT10109L re-treatment 2 for experimental arm
    Arm description
    		 Participants from the experimental arm of Period 1, who met protocol-defined re-treatment criteria, were eligible to receive up to two MT10109L during the open-label part.
    Arm type
    		 Experimental

    Investigational medicinal product name
    MT10109L
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Sterile concentrate
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Retreatment cycle in the open-label period. 5 injection sites per treatment. 0.1 ml per injection. MT10109L - 4 U per 0.1 ml. Total = 20 U per treatment cycle.

    Number of subjects in period 3 [2]
    		MT10109L re-treatment 2 for Placebo arm MT10109L re-treatment 2 for experimental arm
    Started
    52
    99
    Completed
    52
    97
    Not completed
    0
    2
         Consent withdrawn by subject
    -
    1
         Protocol deviation
    -
    1
    Notes
    [2] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Justification - Only participants from the previous treatment period who met a protocol-defined re-treatment criteria entered into the next treatment period.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    		 Placebo was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1.

    Reporting group title
    MT10109L
    Reporting group description
    		 MT10109L was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1

    Reporting group values
    		 Placebo MT10109L Total
    Number of subjects
    		 80 154 234
    Age categorical
    Units: Subjects
        In utero
    		 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    		 0 0 0
        Newborns (0-27 days)
    		 0 0 0
        Infants and toddlers (28 days-23 months)
    		 0 0 0
        Children (2-11 years)
    		 0 0 0
        Adolescents (12-17 years)
    		 0 0 0
        Adults (18-64 years)
    		 77 141 218
        From 65-84 years
    		 3 13 16
        85 years and over
    		 0 0 0
        Adults (18 - 64)
    		 0 0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    		 46.4 ( 11.57 ) 47.3 ( 12.64 ) -
    Gender categorical
    Units: Subjects
        Female
    		 76 140 216
        Male
    		 4 14 18
    Subject analysis sets

    Subject analysis set title
    Demographic and other Baseline Characteristics - ITT
    Subject analysis set type
    		 Intention-to-treat
    Subject analysis set description
    234 participants were included in the Intent To Treat (ITT) population (80 participants in the placebo group and 154 participants in the MT10109L group).

    Subject analysis set title
    Demographic and other Baseline Characteristics -mITT
    Subject analysis set type
    		 Modified intention-to-treat
    Subject analysis set description
    191 participants were included in the modified Intent To Treat (mITT) population (68 participants in the placebo group and 123 participants in the MT10109L group).

    Subject analysis sets values
    		 Demographic and other Baseline Characteristics - ITT Demographic and other Baseline Characteristics -mITT
    Number of subjects
    234
    191
    Age categorical
    Units: Subjects
        In utero
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
        Newborns (0-27 days)
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
        Children (2-11 years)
    0
    0
        Adolescents (12-17 years)
    0
    0
        Adults (18-64 years)
    218
    179
        From 65-84 years
    16
    12
        85 years and over
    0
    0
        Adults (18 - 64)
    0
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    47.0 ( 12.27 )
    48.3 ( 11.49 )
    Gender categorical
    Units: Subjects
        Female
    216
    178
        Male
    18
    13

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    		 Placebo was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1.

    Reporting group title
    MT10109L
    Reporting group description
    		 MT10109L was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1
    Reporting group title
    MT10109L re-treatment 1 for Placebo arm
    Reporting group description
    		 In the open-label part, participants in the placebo arm, who met retreatment criteria, were allowed up to 2 MT10109L treatments.

    Reporting group title
    MT10109L re-treatment 1 for experimental arm in cycle 1
    Reporting group description
    		 Participants from the experimental arm of Period 1, who met protocol-defined re-treatment criteria, were eligible to receive up to two additional MT10109L during the open-label part..
    Reporting group title
    MT10109L re-treatment 2 for Placebo arm
    Reporting group description
    		 In the open-label part, participants in the placebo arm, who met retreatment criteria, were allowed up to 2 MT10109L treatments.

    Reporting group title
    MT10109L re-treatment 2 for experimental arm
    Reporting group description
    		 Participants from the experimental arm of Period 1, who met protocol-defined re-treatment criteria, were eligible to receive up to two MT10109L during the open-label part.

    Subject analysis set title
    Demographic and other Baseline Characteristics - ITT
    Subject analysis set type
    		 Intention-to-treat
    Subject analysis set description
    234 participants were included in the Intent To Treat (ITT) population (80 participants in the placebo group and 154 participants in the MT10109L group).

    Subject analysis set title
    Demographic and other Baseline Characteristics -mITT
    Subject analysis set type
    		 Modified intention-to-treat
    Subject analysis set description
    191 participants were included in the modified Intent To Treat (mITT) population (68 participants in the placebo group and 123 participants in the MT10109L group).

    Primary: Co-Primary: The Percentage of Participants Achieving None or Mild on the FWS According to Participant Assessment of GL Severity at Maximum Frown at Day 30 of Treatment Cycle 1

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    End point title
    		 Co-Primary: The Percentage of Participants Achieving None or Mild on the FWS According to Participant Assessment of GL Severity at Maximum Frown at Day 30 of Treatment Cycle 1
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The data here presents the percentage of participants who had GL severity at maximum frown of none or mild based on participant FWS rating at Cycle 1 Day 30. FWS is 4-point grading scale, where 0=none, 1=mild, 2=moderate, and 3=severe.
    End point type
    Primary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    68
    123
    Units: Participants
    3
    80
    Statistical analysis title
    		 % of Participants Achieving Co-primary endpoint
    Statistical analysis description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. Multiple imputation method was used for missing variables in primary efficacy endpoint.
    Comparison groups
    Placebo v MT10109L
    Number of subjects included in analysis
    191
    Analysis specification
    Pre-specified
    Analysis type
    		 superiority [1]
    P-value
    		 < 0.001
    Method
    		 Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [1] - The equality of the proportions of responders was analyzed using the CMH tests stratified by GL baseline severity.

    Primary: Primary: The Percentage of Participants Achieving None or Mild on the FWS According to Investigator Assessment of GL Severity at Maximum Frown at Day 30 of Treatment Cycle 1

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    End point title
    		 Primary: The Percentage of Participants Achieving None or Mild on the FWS According to Investigator Assessment of GL Severity at Maximum Frown at Day 30 of Treatment Cycle 1
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The data here presents the percentage of participants who had GL severity at maximum frown of none or mild based on investigator FWS rating at Cycle 1 Day 30. FWS is 4-point grading scale, where 0=none, 1=mild, 2=moderate, and 3=severe.
    End point type
    Primary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    68
    123
    Units: Participants
    3
    95
    Statistical analysis title
    		 % of Participants Achieving Primary Endpoint
    Statistical analysis description
    Primary efficacy analyses endpoints were carried out using the modified Intent-To-Treat (mITT) analysis set, which which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. Multiple imputation method was used for missing variables in primary efficacy endpoint.
    Comparison groups
    Placebo v MT10109L
    Number of subjects included in analysis
    191
    Analysis specification
    Pre-specified
    Analysis type
    		 superiority [2]
    P-value
    		 < 0.001
    Method
    		 Cochran-Mantel-Haenszel
    Confidence interval
    Notes
    [2] - The equality of the proportions of responders was analyzed using the CMH tests stratified by GL baseline severity.

    Secondary: Secondary 4: The Percentage of Responders for Investigator Assessments of GL Severity at Rest Using the FWS Among Participants Who were Rated at least Mild at Rest at Baseline, Where a Responder was Defined as Achieving ≥1-grade Improvement from Baseline

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    End point title
    		 Secondary 4: The Percentage of Responders for Investigator Assessments of GL Severity at Rest Using the FWS Among Participants Who were Rated at least Mild at Rest at Baseline, Where a Responder was Defined as Achieving ≥1-grade Improvement from Baseline
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥1-grade improvement from baseline GL severity at rest based on investigator FWS rating is presented here. FWS is a 4-grade scale (0 to 3) where 0 = none and 3 = severe.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    62
    115
    Units: Participants
    23
    76
    No statistical analyses for this end point

    Secondary: Secondary 1:The Duration of GL Treatment Effect, Estimated as the Median Time to Return to Moderate or Severe GL at Maximum Frown, in Participants Who Achieved a Rating of None or Mild from Baseline in GL Severity at Maximum Frown at Day 30

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    End point title
    		 Secondary 1:The Duration of GL Treatment Effect, Estimated as the Median Time to Return to Moderate or Severe GL at Maximum Frown, in Participants Who Achieved a Rating of None or Mild from Baseline in GL Severity at Maximum Frown at Day 30
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The investigator evaluates the participant's GL severity using a 4-grade FWS scale (0 to 3) where 0=none and 3 = severe. The outcome is measured as median time to loss of treatment effect (i.e., return to moderate or severe GL severity at maximum frown using the FWS). FWS is a 4-grade scale (0 to 3) where 0 = none and 3 = severe.
    End point type
    Secondary
    End point timeframe
    Day 1 (first treatment) to Day 180
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    3
    95
    Units: Days
        median (inter-quartile range (Q1-Q3))
    64 (59 to 126)
    120 (87 to 149)
    No statistical analyses for this end point

    Secondary: Secondary 2: The Percentage of Participants Reporting Mostly Satisfied/Very Satisfied on a 5-Point Scale of Very Dissatisfied to Very Satisfied at Day 60 on the FLSQ Follow-up Version Item 5 for GL

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    End point title
    		 Secondary 2: The Percentage of Participants Reporting Mostly Satisfied/Very Satisfied on a 5-Point Scale of Very Dissatisfied to Very Satisfied at Day 60 on the FLSQ Follow-up Version Item 5 for GL
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The Satisfaction Question 5, grades facial line treatment satisfaction on a 5-point scale (-2 to 2) where -2=Very dissatisfied and 2=Very satisfied.
    End point type
    Secondary
    End point timeframe
    Day 60
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    63
    120
    Units: Participants
    5
    99
    No statistical analyses for this end point

    Secondary: Secondary 3: The Percentage of Participants with ≥20-point Improvement from Baseline at Day 30 on the FLSQ Impact Domain for GL

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    End point title
    		 Secondary 3: The Percentage of Participants with ≥20-point Improvement from Baseline at Day 30 on the FLSQ Impact Domain for GL
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥20-point improvement from baseline on the FLSQ impact domain (eg, reported a good improvement of the facial lines negative impact) are presented here.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    66
    121
    Units: Participants
    6
    90
    No statistical analyses for this end point

    Secondary: Secondary 5: The Percentage of Responders for Participant Assessments of GL Severity at Rest Using the FWS Among Participants Who were Rated at least Mild at Rest at Baseline, Where a Responder was Defined as Achieving ≥1-grade Improvement at Day 30

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    End point title
    		 Secondary 5: The Percentage of Responders for Participant Assessments of GL Severity at Rest Using the FWS Among Participants Who were Rated at least Mild at Rest at Baseline, Where a Responder was Defined as Achieving ≥1-grade Improvement at Day 30
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥1-grade improvement from baseline GL severity at rest based on participant FWS rating is presented here. FWS is a 4-grade scale (0 to 3) where 0 = none and 3 = severe.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    62
    115
    Units: Participants
    7
    76
    No statistical analyses for this end point

    Secondary: Secondary 6: The Percentage of participants with a ≥ 20-point improvement from baseline at Day 30 on the FLO-11© questionnaire total score for GL

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    End point title
    		 Secondary 6: The Percentage of participants with a ≥ 20-point improvement from baseline at Day 30 on the FLO-11© questionnaire total score for GL
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥20-point improvement from baseline on the FLO-11 questionnaire for GL (eg, reported less emotional and appearance-related impacts of upper-facial lines) is presented here.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    66
    123
    Units: Participants
    4
    92
    No statistical analyses for this end point

    Secondary: Secondary 7: The Percentage of participants with a > 4-point improvement from baseline at Day 30 on FLO-11 questionnaire Item 2 for GL

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    End point title
    		 Secondary 7: The Percentage of participants with a > 4-point improvement from baseline at Day 30 on FLO-11 questionnaire Item 2 for GL
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥4-point improvement from baseline on the FLO-11 questionnaire item 2 for GL (eg, reported good improvement in the appearance of skin age) is presented here.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    66
    123
    Units: Participants
    4
    77
    No statistical analyses for this end point

    Secondary: Secondary 8: The Percentage of participants with a > 4-point improvement from baseline at Day 30 on FLO-11 questionnaire Item 5 for GL

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    End point title
    		 Secondary 8: The Percentage of participants with a > 4-point improvement from baseline at Day 30 on FLO-11 questionnaire Item 5 for GL
    End point description
    All primary and secondary efficacy analyses for EU regulatory endpoints were carried out using the mITT population, which consisted of all randomized participants who had a baseline transformed FLO-11 questionnaire total score of ≤50. The percentage of participants who achieved a ≥4-point improvement from baseline on the FLO-11 questionnaire item 5 for GL (eg, reported good improvement in attractiveness) is presented here.
    End point type
    Secondary
    End point timeframe
    Day 30
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    66
    119
    Units: Participants
    6
    65
    No statistical analyses for this end point

    Secondary: Secondary 9: Mean Change From Baseline in Vital Signs - Systolic Blood Pressure (BP)

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    End point title
    		 Secondary 9: Mean Change From Baseline in Vital Signs - Systolic Blood Pressure (BP)
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or Early exit.
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    73
    133
    Units: mm Hg
        arithmetic mean (standard deviation)
    0.3 ( 13.26 )
    -0.6 ( 15.28 )
    No statistical analyses for this end point

    Secondary: Secondary 10: Mean Change From Baseline in Vital Signs - Diastolic Blood Pressure (BP)

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    End point title
    		 Secondary 10: Mean Change From Baseline in Vital Signs - Diastolic Blood Pressure (BP)
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    73
    133
    Units: mm Hg
        arithmetic mean (standard deviation)
    0.5 ( 10.04 )
    -1.9 ( 10.64 )
    No statistical analyses for this end point

    Secondary: Secondary 11: Mean Change From Baseline in Vital Signs - Respiratory rate

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    End point title
    		 Secondary 11: Mean Change From Baseline in Vital Signs - Respiratory rate
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    73
    133
    Units: breath/min
        arithmetic mean (standard deviation)
    -0.3 ( 2.44 )
    -0.3 ( 2.18 )
    No statistical analyses for this end point

    Secondary: Secondary 12: Mean Change From Baseline in Vital Signs - Pulse Rate

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    End point title
    		 Secondary 12: Mean Change From Baseline in Vital Signs - Pulse Rate
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    73
    133
    Units: beats/min
        arithmetic mean (standard deviation)
    2.5 ( 10.35 )
    0.4 ( 10.54 )
    No statistical analyses for this end point

    Secondary: Secondary 13: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - Heart Rate

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    End point title
    		 Secondary 13: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - Heart Rate
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: beats/min
        arithmetic mean (standard deviation)
    4.8 ( 10.38 )
    2.8 ( 8.52 )
    No statistical analyses for this end point

    Secondary: Secondary 14: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - PR Interval

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    End point title
    		 Secondary 14: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - PR Interval
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    -1.2 ( 11.67 )
    -1.2 ( 11.91 )
    No statistical analyses for this end point

    Secondary: Secondary 15: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QRS Duration

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    End point title
    		 Secondary 15: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QRS Duration
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    0.4 ( 6.65 )
    1.2 ( 6.41 )
    No statistical analyses for this end point

    Secondary: Secondary 16: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QT Interval

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    End point title
    		 Secondary 16: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QT Interval
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    -11.7 ( 23.87 )
    -8.4 ( 19.71 )
    No statistical analyses for this end point

    Secondary: Secondary 17: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QTcB Interval

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    End point title
    		 Secondary 17: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QTcB Interval
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    2.7 ( 18.69 )
    0.0 ( 17.14 )
    No statistical analyses for this end point

    Secondary: Secondary 18: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QTcF Interval

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    End point title
    		 Secondary 18: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - QTcF Interval
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    -2.4 ( 15.43 )
    -2.9 ( 14.06 )
    No statistical analyses for this end point

    Secondary: Secondary 19: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - RR Interval

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    End point title
    		 Secondary 19: Mean Change From Baseline in Electrocardiogram (ECG) Parameters - RR Interval
    End point description
    Change from baseline at study exit. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments.
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    70
    130
    Units: milliseconds
        arithmetic mean (standard deviation)
    -64.6 ( 127.1 )
    -39.3 ( 106.19 )
    No statistical analyses for this end point

    Secondary: Secondary 20:Number of Participants With Binding and Neutralizing Antibodies

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    End point title
    		 Secondary 20:Number of Participants With Binding and Neutralizing Antibodies
    End point description
    Only samples that tested positive in the binding antibody confirmatory assay were evaluated for neutralizing antibodies. The participants with positive neutralizing antibodies are only shown. All safety analyses were carried out using Safety Population which includes all subjects who received at least 1 study treatment injection. In open-label period, subjects from both placebo group and MT10109L group who met re-treatment criteria were allowed up to two MT10109L re-treatments
    End point type
    Secondary
    End point timeframe
    Day 360 or early exit
    End point values
    		 Placebo MT10109L
    Number of subjects analysed
    80
    154
    Units: Participants
    1
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    The time frame for AEs is from the first dose on Day 1 and up to 30 days after their last visit or study exit (Day 360 or early exit).
    Adverse event reporting additional description
    Safety analyses were carried out using the Safety population (participants who received at least 1 dose of study intervention). Placebo participants who entered open-label phase (post Day 180) and received study intervention are counted in MT10109L Group. Thus, overall number of participants in MT10109L Group is greater than the participant flow.
    Assessment type
    		 Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    		 MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    		 Placebo was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1. In the open-label period (post day 180), up to 2 MT10109L treatments were possible. TEAEs with onset date after the MT10109L treatment were not counted here.

    Reporting group title
    MT10109L
    Reporting group description
    		 MT10109L was injected into the Glabellar Lines (GL): initial double-blind treatment on Day 1, and up to 2 open-label study interventions during the retreatment period. Placebo participants who experienced TEAE after receiving MT10109L during open-label phase were counted here.

    Serious adverse events
    		 Placebo MT10109L
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 80 (3.75%)
    5 / 223 (2.24%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast Cancer
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast Cancer Stage II
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Malignant Melanoma in situ
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Radius fracture
         subjects affected / exposed
    1 / 80 (1.25%)
    0 / 223 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    1 / 80 (1.25%)
    0 / 223 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intentional Overdose
         subjects affected / exposed
    1 / 80 (1.25%)
    0 / 223 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Rectal prolapse
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    COVID-19 pneumonia
         subjects affected / exposed
    0 / 80 (0.00%)
    1 / 223 (0.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 80 (1.25%)
    0 / 223 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    		 Placebo MT10109L
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    8 / 80 (10.00%)
    32 / 223 (14.35%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    4 / 80 (5.00%)
    22 / 223 (9.87%)
         occurrences all number
    4
    22
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    4 / 80 (5.00%)
    16 / 223 (7.17%)
         occurrences all number
    4
    16

    More information

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    Substantial protocol amendments (globally)
    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 Feb 2019
    The primary purpose of this protocol amendment was to integrate feedback and recommendations from health authorities and improve clarity of study processes. This amendment is considered substantial based on the criteria set forth in Article 10(a) of Directive 2001/20/EC of the European Parliament and the Council of the European Union.

    Interruptions (globally)
    Were there any global interruptions to the trial? No

    Limitations and caveats
    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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