Clinical comparisons of botulinum neurotoxin formulations

The expanding uses of botulinum neurotoxin (BoNT) for a growing number of clinical indications, including cervical and other dystonias, adult and childhood spasticity, and hyperhidrosis, in conjunction with the emergence of new formulations of BoNT, prompt discussion of the differences in formulations, serotypes, and indications for different neurologic diseases.

This review will evaluate evidence from preclinical studies, prospective treatment studies, and direct comparative trials to discuss the differences among BoNTs and the clinical implications of using these different drugs. Data from these sources indicate that formulations of BoNT are distinct; even the same serotype formulations of BoNT serotype A have different molecular structures and sizes and therapeutic indices (reflected in different safety and efficacy profiles).

Taken together, these findings confirm that the different BoNT serotypes, including the different BoNTA formulations, are distinct therapeutic entities.