A 2018 review provided a critical appraisal of the pharmacological distinctions and clinical implications of the three commercially available botulinum toxin serotype A (BoNTA) preparations: onabotulinumtoxinA (Botox), abobotulinumtoxinA, and incobotulinumtoxinA (Xeomin). Botox and abobotulinumtoxinA include botulinum neurotoxin protein complexes of varying molecular weights, with the former consisting of a 900 kDa complex and the latter a 400 kDa complex. In contrast, Xeomin is a purified 150 kDa neurotoxin devoid of accessory proteins. These structural differences, combined with distinct production and stabilization methods, result in non-interchangeable products with specific pharmacokinetics, dosing requirements, and clinical applications. Notably, potency evaluations revealed variations in neurotoxin load per 100 units, with specific neurotoxin potency values calculated as 137 units/ng for Botox and 227 units/ng for Xeomin. Pharmacological studies suggest that Botox has a greater effect and longer duration compared to Xeomin but also predisposes Botox to a greater risk of adverse events. Ultimately, the choice of BoNTA should be individualized per patient, reinforced by the pharmacotherapeutic profiles of each product. [1]
A 2022 network meta-analysis of 18 randomized controlled trials (RCTs) involving 4,706 participants investigated the efficacy and safety of various BoNTA formulations for treating moderate-to-severe glabellar lines. The analysis involved six BoNT/A formulations, including Botox and Xeomin. Outcomes Assessed the proportion of participants achieving a glabellar line severity score of none or mild at maximal frown by one month, at least 1-point or 2-point improvement on standardized scales, and related adverse events (AEs). The analysis demonstrated that all BoNT/A formulations significantly outperformed placebo in achieving aesthetic improvement, with daxibotulinumtoxinA showing the highest efficacy. While incremental differences in 2-point improvement efficacy were noted, statistical significance was not achieved for this metric. Safety outcomes indicated a low incidence of adverse events across all formulations, and no significant differences were observed between BoNT/A products, although all formulations carried higher risk than placebo. Ranking probabilities using SUCRA identified daxibotulinumtoxinA as the most effective, while Botox typically ranked above Xeomin. [2]
A 2016 analysis systematically evaluated the efficacy and safety of botulinum toxin formulations for the treatment of cervical dystonia (CD) using a Bayesian mixed treatment comparison (MTC) model. The analysis incorporated data from 11 RCTs involving 1,295 participants and focused on five botulinum toxin including Botox and Xeomin. According to the Bayesian analysis, Botox, Xeomin, and the other three BoTNs demonstrated significant efficacy compared to placebo, with median improvements in The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores ranging between -5.78 and -8.22 across the five BoNT. Xeomin appears to have demonstrated the greatest effect in TWSTRS total scores but was not statistically different from the other toxins. Overall, the comparable efficacy and safety profiles of Dysport and Xeomin in managing cervical dystonia were similar, affirming their utility as potential first-line options in clinical practice. [3]