Prof Berthold RZANY
Dermatologue
Same or different - What counts when it come to choosing botulinum toxins?
Objectives: To give some objective and subjective criteria on how to choose a botulinumtoxin
Introduction: All toxins coming to the market are approved botulinum toxin A products. Therefore, they basically have the same sound background of good clinical trials. However, when you have them in your hands you will realize that they differ when it comes to efficacy and duration of effect. So which criteria to use?
Materials / method: Eminence based including a rough search of the literature
Results: If you are looking for high efficacy and long duration you need to choose the toxins with the presumably highest 150kD content per vial. There is no study which compares ALL available toxins. However, there might be some studies that could be helpful: (1) non-inferiority studies (2) studies in male patients E.g. if a toxin as a good as the compared one and is going in the direction of superiority that’s not a bad sign same as if a toxin does well in male patients. Softer criteria are marketing descriptions and prize. Giving 'natural results' and a lower prize might point to less 150kD per vial
Conclusion: All toxins on the market are safe and efficacious but they may vary in 150KD content. To obtain similar results some toxins might need to be dosed higher as the labeled dosage. Clinical study data might give you some hints as well as prizing. Last not least – or may be the best - try the toxin yourself and see how it works with the labeled dosage in your patients.
