Routine use of Xeomin in patients previously treated with Botox: long term results

Abstract

Background and purpose: Based upon large and carefully performed studies Xeomin was first registered in 2005. However, its real potential can only be assessed, when it is used outside of study design restrictions, in an independent setting, in off-label indications and during continued use.

Methods and results: Two hundred and sixty-three patients (91 with dystonia, 84 with spasticity, 17 with hemifacial spasm and re-innervation synkinesias, 64 with hyperhidrosis, 7 with hypersalivation), who were previously treated with Botox for at least 1 year under stable conditions, were converted in a blinded fashion to Xeomin using a 1:1 conversion ratio and identical treatment parameters. Therapeutic outcome and adverse effects were monitored by neurological examination and structuralised interviews. In 223 patients (all except those with axillary hyperhidrosis) Xeomin was used continuously throughout a 3 year period. Altogether 1050 injection series were performed. Patients with dystonia received 261.5 +/- 141.0 MU Botox/Xeomin, patients with spasticity 450.5 +/- 177.1 MU, patients with hemifacial spasm and reinnervation synkinesias 44.7 +/- 19.5 MU and patients with hyperhidrosis 286.9 +/- 141.6 MU. The maximum botulinum toxin dose applied was 840 MU. There were no subjective or objective differences between Botox and Xeomin treatments with respect to onset latency, maximum and duration of their therapeutic effects and their adverse effect profiles. Long-term use did not reveal additional safety relevant aspects. None of the patients lost therapeutic efficacy during the observation period.

Conclusions: Xeomin can be used safely in doses of up to 840 MU. Even when applied in high doses it did not produce secondary therapy failure. There were no diffusion differences between Botox and Xeomin. Using a conversion ratio of 1:1 Xeomin and Botox can easily be exchanged in a continued treatment.