Even though conventional
botulinum neurotoxin (BoNT) products have shown successful treatment results in patients with benign
blepharospasm (BEB), the main, potential long-term side effect of BoNT use is the development of immunologic resistance due to the production of
neutralizing antibody to the
neurotoxin after repeated
injections.
Xeomin(®) (
incobotulinumtoxinA), a unique
botulinum neurotoxin type A (
BoNT/A)
drug free of complexing
proteins otherwise contained in all conventional
BoNT/A drugs, was recently approved by US Food and Drug Administration for the treatment of
cervical dystonia or
blepharospasm in adults. The newly approved
BoNT/A drug may overcome this limitation of previous conventional products, since it contains pure
neurotoxin (150 kDa) through a manufacturing process that separates it from complexing
proteins such as
hemagglutinins produced by fermentation of Clostridium botulinum. Many studies have also shown that
Xeomin(®) has the same efficacy and safety profile as complexing
protein-containing products such as
Botox(®) and is exchangeable with
Botox(®) using a simple 1:1 conversion ratio.
Xeomin(®) represents a new treatment option for the repeated treatment of patients with
blepharospasm in that it may reduce antibody-induced
therapy failure. But, long-term comparative trials in naïve patients between
Xeomin(®) and conventional
BoNT/A drugs are required to confirm the low immunogenicity of
Xeomin(®).