What is the Difference between Botox®, Xeomin®, and Dysport®?

By Dr. Stephen Cosentino

PRESIDENT OF EMPIRE MEDICAL TRAINING We are often asked as which Botulinum Toxin A product works best? and what is the difference in the product?  Besides popularity and brand recognition there is little difference between the (3) products.  All of the Botulinum Toxin-A products work in the same manner other than the characteristics of each of the products are different. Each of the FDA Approved Botulinum Toxin A products are produced from fermentation of the Hall strain Clostridium Botulinum type A bacteria and their mechanism of action of binding to acceptor sites on motor or sympathetic nerves is similar. So what makes each of these products unique and preferred by physicians and patients?  The answer ends up being patient preference and physician preference.  There can never be a double-blind study comparison stating one is better than the other since each of the botulinum neurotoxin preparations are unique The following table compares the physical product characteristics of Botox®, Xeomin®, and Dysport®:

	Botox® OnabotulinumtoxinA	Xeomin® IncobotulinumtoxinA	Dysport® AbobotulinumtoxinA
Strain of C. Botulinum	Hall	Hall	NCTC 2916 (Hall)
Serotype	A	A	A
Isolation Method	Dialysis, Acid Precipitation	Dialysis, Acid Precipitation	Acid Precip, Column Chromatography
Complex Molecular Weight	900	200-300	500-900
Neurotoxin Protein-ng/vial	+/-  5	n/a	12.5
Formulation	Vacuum Dried	Lyophilized	Lyophilized
Excipients	Human Albumin 0.9% NaCl	Human Albumin Sucrose	Human Albumin Lactose

The only real difference between the products are the molecular weight, protein content, and the excipient used.  This may explain why some patients believe one product works sooner than others – smaller molecular weight.  Other explanations by physicians include that certain products such as Botox® and Dysport® have greater diffusion across the muscle group – suggesting the protein and molecular weight in attaching to the various sites of the motor and sympathetic nerves.  These are all theories that will be debated over time without any real answer.  The real answer is that all of the various products work and have been verified through the FDA process as safe and effective.  You will need to experiment with all of the Botulinum Toxin products and choose which ones fit your patient needs and economically feasible for your practice. The views expressed in this article are based on the authors' opinion of the product and not from the manufacturers Empire Medical Training provides Botox Training for Physicians, Dentists, Nurses and other healthcare professionals nation-wide.