Botox vs Xeomin

This post is very similar to the previous blog post, Botox vs Dysport: Battle of the Neuromodulators, Part I”, with some parts borrowed directly.

Botox and Xeomin are both formulations of botulinum toxin type A.  For reference the bacteria Clostridium botulinum makes eight different types of toxins (A, B, C1, C2, D, E, F, and G).  The molecule naturally occurs as a protein-toxin complex, with a large carrier molecule and a comparably smaller toxin molecule.

Botox (onabotulinumtoxin A) is made by Allergan, and is supplied as a lyophilized (dried) form, and a vial of Botox contains a small amount of human serum albumin (a protein), sodium chloride (salt), and the neurotoxin complex, a protein-toxin complex with a mass of 900kD.  Botox is typically available in 100 unit and 50 unit vials.  The vials have to be refrigerated and stay that way until they are reconstituted with normal saline and then injected.

Xeomin (incobotulinumtoxin A) is made by Merz, and is also supplied as a lyophilized powder, with vials containing human serum albumin, sucrose, and the neurotoxin.  The big difference between Botox, Dysport, and Xeomin is that Xeomin does not contain the carrier protein that the other two products have.  Proteins are quite sensitive molecules, as any change in pH, temperature, salt concentration, or agitation may disrupt them (turn the proteins inside out and therefore ineffective).  Lacking a protein, Xeomin is stable at room temperature and does not require refrigeration before or after reconstitution with saline.  To help me sleep better at night, and since we have the room, I do keep my Xeomin refrigerated, as I do not have a compelling reason not to.

Does the small, pure toxin travel much farther in the body because it is not as “heavy” as Botox?  It does make sense.  Though, not everything makes sense.  See this example: 

  1. Dried grapes are raisins
  2. Dried plums are prunes
  3. You walk around the grocery store and see a lot of grape juice.  No raisin juice in sight. 
  4. You walk around the grocery store and see a lot of prune juice.  No plum juice in sight.

Not everything that makes sense actually works the way you think, and just because something is a good idea on paper does not mean that it actually works.  I see the marketing folks (understandably) try to really press on this size issue, as it is the key difference between these two products.  

Multiple studies in the peer-reviewed medical literature have been done, with a couple listed at the bottom of this posting.  There would be a lot (billions of dollars) to gain if someone can prove that their product is in fact superior to others.  This should be easy enough to do, as these products are being injected constantly and globally in all skin types.  

There are no such studies.  There are, however, several studies that show that they are equivalent.  As Xeomin is a newer product than Botox and Dysport, there is much more literature comparing the latter two compared to each other than there are that involve Xeomin.  At the end of the day, these are all products that are the same flavor of toxin but just formulated to be different sizes.  I am not convinced that anyone has shown that this difference actually matters.

Medical Literature Citations:

J Neural Transm (Vienna). 2014 Jan;121(1):21-6. 

Dermatol Surg. 2015 Nov;41(11):1310-9.