Considerations on patient-related outcomes with the use of botulinum toxins: is switching products safe?

Figures & data

Table 1 Types of botulinum toxin

Generic name	Trade name	Serotype	Molecular weight (kDa)	Target	Manufacturer
Onabotulinumtoxin A	Botox	A	900	SNAP-25	Allergan, Inc. (Irvine, CA, USA)
Abobotulinumtoxin A	Dysport	A	500–900	SNAP-25	Ipsen Biopharmaceuticals, Inc. (Paris, France)
Incobotulinumtoxin A	Xeomin	A	150	SNAP-25	Merz Pharmaceuticals (Frankfurt, Germany)
Rimabotulinumtoxin B	Myobloc	B	700	Synaptobrevin	Solstice Neurosciences (US WorldMeds; Louisville, KY, USA)

Abbreviation: SNAP-25, synaptosomal-associated protein 25.

Table 2 Comparing Onabot and Abobot

Study	Indication	Dosing ratio	Efficacy	Tolerability
Sampaio et al^Citation8	BPS, HFS	1:4	Equal	Equal
Nussgens and Roggenkamper^Citation7	BPS, HFS	1:4	Equal	Onabot > Abobot
Odergren et al^Citation9	CD	1:3	Equal	Equal
Ranoux et al^Citation34	CD	1:3 and 1:4	Abobot > Onabot	Onabot > Abobot
Bihari^Citation24	BPS, CD, or HFS	1:4 to 1:5	Onabot > Abobot	Onabot > Abobot
Marchetti et al^Citation25	BS or CD	1:2 to 1:11	NA	Onabot > Abobot
Bentivoglio et al^Citation13	BPS or HFS	1:1.2 to 1:13.3	Equal	Equal

Abbreviations: Abobot, abobotulinumtoxin A; BPS, blepharospasm; CD, cervical dystonia; HFS, hemifacial spasm; NA, not available; Onabot, onabotulinumtoxin A.

Table 3 Comparing Onabot and Incobot

Study	Indication	Dosing ratio	Efficacy	Other
Wabbels et al^Citation16	BPS	1:1	Equal	No difference in frequency of adverse events
Saad and Gourdeau^Citation17	BPS	1:1	Equal	Used the “split-face” technique
Dressler et al^Citation19	CD	1:1	Equal

Abbreviations: BPS, blepharospasm; CD, cervical dystonia; Incobot, incobotulinumtoxin A; Onabot, onabotulinumtoxin A.

Table 4 Switching studies

Study	Indication	Methods	Details	Efficacy	Other
Brin et al^Citation23	CD	Giving BoNT-B to Onabot failures	Placebo or 10,000 units BoNT-B	Equal	More dry mouth and dysphagia in BoNT-B
Bihari^Citation24	BPS, HFS, CD	Compared Abobot with Onabot	Dose ratio of 4:1 for BPS and 5:1 for CD and HFS	Onabot > Abobot for all three indications	Longer duration of benefit for Onabot, more adverse events for Abobot
Marchetti et al^Citation25	CD, BPS	Compared Abobot with Onabot	Dosing ratios ranges from 2:1 to 11:1	Abobot was equally effective over a range of doses	Could not recommend a fixed dosing ratio
Badarny et al^Citation35	BPS, HFS	Compared Onabot with Abobot	Used conversion ratio of 1:3 or 1:4	Two patients who never responded to Onabot did respond to Abobot. Two patients with secondary failure to Onabot responded to Abobot	Onabot and Abobot have different pharmacologic and biological activity, and should be considered different medications
Dutton et al^Citation26	BPS, HFS	Switching from Onabot to Rimabot	Average dose of 3,633 units of Rimabot per session over 7.3 weeks	Response rated as “fair to excellent”	More side effects with Rimabot and a shorter duration of benefit

Abbreviations: Abobot, abobotulinumtoxin A; BoNT, botulinum toxin; BPS, blepharospasm; CD, cervical dystonia; HFS, hemifacial spasm; Onabot, onabotulinumtoxin; Rimabot, rimabotulinumtoxin B.

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