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Xeomin® vs Botox® vs Dysport® Explained

Xeomin® is an incobotulinumtoxinA product and is a competitor to the more recognized Botox Cosmetic® and also Dysport®. 

The IAPAM queried its faculty for an overview of the differences between the 3 products.  

All the experts we queried agreed that the key to using any of these products:  Botox® vs Dysport® vs Xeomin® is to first engage in a comprehensive injectables training program that includes all three as part of the didactic.

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Executive Summary Xeomin® vs Botox® vs Dysport®

  • The main difference between Xeomin® and Botox® or Dysport®, is that Xeomin® contains just one ingredient: botulinum toxin A.
  • The manufacturing process is slightly different with all 3, which leads to some potential, subtle differences in clinical practice.
  • Xeomin® is a “naked injectable,” meaning that it does not contain any additives. A benefit of a pure-form injectable is that the human body is less likely to become resistant to it. Some patients have developed antibodies to Botox® and Dysport®.
  • Xeomin® is the only one of the three (Xeomin®, Botox® and Dysport®) injectables that does not need to be refrigerated before use, due to its lack of additives.
  • The cost of Xeomin® is roughly the same as for Botox at $5.00-5.40 per unit.  Dysport® is about $3.99 per unit.
  • Patients average 20 units of Xeomin® per visit, vs. 20 units of Botox and 40 units of Dysport®.
  • The average retail cost to a patient in the US, for a Xeomin® treatment, is between $300.00 – $400.00 every 3 months based on the recommended dose of 20 Units per treatment session.
  • Xeomin® might have the slowest “onset” of action of the 3 (Dysport® onset in 24 hours, Botox onset in 72 hours, and Xeomin® onset in 4 days.)
  • Xeomin® may be “mildly more convenient” than Botox® or Dysport®, as the “product’s lack of complex proteins will help prevent antibody formation, or resistance to neuromuscular treatment with botulinum type A toxin, in patients being treated for neuromuscular conditions.”
  • Neurotoxins diffuse differently, in part because Botox® and Dysport® have protective proteins clustered around the active part of the molecule, while Xeomin® has no protective proteins.
  • Botox® has a full complement of protective proteins and weighs about 900 kD. Dysport® is a mixture of 500 kD and 300 kD complexes of protective proteins and botulinum toxin A. Being heavier, these complexes migrate more slowly than Xeomin/NT-201, which is BTX-A without protective proteins. Conversely, you will have less precision.
  • Dysport® has been shown to “drift” or diffuse more than Botox, increasing the chances of an accidental droopy eyelid or unintentional relaxation of a neighboring muscle due to diffusion of the product.
  • Botox® and Dysport® are not interchangeable because the products are dosed and injected differently.

For a complete overview on Xeomin®:  Instructions for Preparation, Dosage and Administration, please visit https://iapam.com/xeomin-incobotulinumtoxina

A Comparison of Xeomin®, Botox®, Dysport®

Since Botox®, in comparison to Dysport® and Xeomin®, is the more commonly used neurotoxin in aesthetic medicine.

Botox®, scientifically known as onabotulinumtoxin A, works by causing temporary paralysis of muscles in the area where it is injected. It is used mainly to manage fine lines and wrinkles, as well as treatment of migraines.

Dysport®, which is scientifically known as abobotulinumtoxin A, is similar to Botox®, except that currently it is used mainly in the treatment of cervical dystonia. Finally, Xeomin®- or scientifically known as icobotulinumtoxin A, has very similar uses and protocols as Botox®.

Botox® vs Dysport®

As mentioned above, both Dysport® and Botox® cause paralysis in the neuromuscular junction. They are both used for treating fine lines and wrinkles. However, their differences are more extensive.

Dysport® is usually used to manage cervical dystonia, or spasmodic torticollis, which is an abnormal tone in the muscles of the neck, resulting in an abnormal head position. Botox® is not usually used to treat this condition.

Further, Dysport® has the ability to take effects on the injection site a lot faster than Botox®. For example, it is estimated that the results of Dysport® are seen around 48 hours after injection while Botox® can take up to 7 days to show any results.

The duration of action between the two is also quite different. For example, it is estimated that Dysport® can last up to 4 months. How long does Botox® last? Typically, it only lasts around 3 months. This ultimately has an effect on how many injections will have to be administered to patients who need long-term treatment.

However, one needs to consider the dosages of the drugs, as larger doses of Dysport® need to be given – 3 units – compared to Botox®, which only needs one unit, to see results.

Finally, Dysport® is cheaper than Botox®, and the storage of the two products differs. Botox® is freeze-dried and needs to be stored either frozen at -5°C or refrigerated between 2 to 8°C until it three. Dysport® only needs to be stored between 2 to 8°C once it is re-formed for use.  For more information from the IAPAM’s faculty of dermatologists, please read our expert discussion on Botox® vs Dysport®.

Explaining Xeomin® vs. Botox®

Aesthetic medicine now uses botulinum toxin regularly in treating a variety of skin and muscle problems. 

Xeomin® and Botox® are two commonly used preparations, and in this article, we will review the similarities and differences between these two preparations.

Similarities

There are a number of similarities between Xeomin® and Botox®. These are listed below –

1. Both Xeomin® and Botox® consist of the same basic ingredient – Botulinum toxin A, a toxin that this produced by the Clostridium botulinum bacteria. This neurotoxin acts by blocking the neuromuscular junction and has an effect on the skin and muscles it is injected into.

2. Both Xeomin® and Botox® exert their effect in around 7 days after it has been injected, with the effects lasting up to 6 months. The overall effect that results from Xeomin® and Botox® are the same.

3. Both Xeomin® and Botox® are measured in the same units, making it easy for the treating physician to measure up the required dose.

4. The cost of Xeomin® and Botox® are comparable, making the administration of either drug a choice that can lie with the physician or the patient.

Differences

There are only a few differences between Xeomin® and Botox®. These have been listed below:

1. The basic structure of Xeomin® and Botox® are different, even though the toxin is the same. Botox® is encased within a protein structure, while Xeomin lacks this protein covering and is, in fact, the ‘naked’ botulinum toxin. This protein casing on Botox can cause immune reactions that can eventually block the actions on botulinum toxin when injected.  It is believed that this is an advantage that Xeomin® bears over Botox as it results in no antibody formation with repeated injections of Xeomin®.

2. Botox® is stored in a freezer or at temperatures between 2 to 8°C. It, therefore, requires it to be transported in a freezer. On the other hand, Xeomin® does not necessarily need to be stored in a freezer or refrigerator, making transporting the product a lot easier and even cheaper.

3. Xeomin® is manufactured by Merz Pharma while Botox® is manufactured by Allergan.

In most cases, Xeomin® can be offered if patients develop antibodies to Botox®.

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Please note: Botox, Allergan Botox Cosmetic and Juvederm are registered trademarks of Allergan, Inc. Dysport, Restylane and Perlane are registered trademarks of Galderma. Xeomin is a registered trademark of Merz Pharmaceuticals, LLC.

DISCLOSURE OF UNLABELED USE  

This document contains a discussion of agents that are not indicated by the U.S. Food and Drug Administration.  The International Association for Physicians in Aesthetic Medicine (IAPAM), Allergan, Inc., and Medicis, Inc., do not recommend the use of any agent outside of the labeled indications. The opinions expressed in this document are those of the contributors and do not necessarily represent the views of the IAPAM, Allergan, Inc. or Medicis, Inc. Please refer to the official prescribing information for each product for discussion of approved indications,  contraindications, and warnings.

Copyright, Legal Notice and Disclaimer

The information presented in this document is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. This publication is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and local laws, and all rights are reserved, including resale rights: you are not allowed to give or sell this e-book to anyone else. No part of this e_report may be reproduced in any form by any means (including electronic, photocopying, recording, scanning, or otherwise) without prior written permission of the publisher.

Please note that much of this publication is based on personal experience and anecdotal evidence. Although the author(s) and publisher have made every reasonable attempt to achieve complete accuracy of the content in this text, they assume no responsibility for errors or omissions. Also, you should use this information as you see fit, and at your own risk. Your particular situation may not be exactly suited to the examples illustrated here; in fact, it’s likely that they won’t be the same, and you should adjust your use of the information and recommendations accordingly.

Any trademarks, service marks, product names or named features are assumed to be the property of their respective owners and are used only for reference. There is no implied endorsement if we use one of these terms. Please note that the information presented on these pages is for informational purposes only. The IAPAM (or its affiliates), shall not be liable to anyone for any loss or injury caused in whole or in part by your use of this information, or for any decision you make or action you take in reliance on information you received from this text. This text is not intended to replace legal, medical, accounting or other professional advice, and is only meant to be used as a guideline for the reader. Any information in this publication should not be considered a substitute for consultation with a physician to address individual medical needs.

 

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