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Tuesday
Aug022011

Xeomin vs. Botox vs. Dysport

Botox & Dysport now have a new contender in the cosmetic space... Xeomin.

About Xeomin: (pronouced ZEE-oh-min) from Merz Pharma GmbH & Co KGaA

Download the Xeomin Report PDF

Botox, Dysport and Xeomin have a lot in common, but they also have some important differences. Unlike both Botox and Dysport, Xeomin does not need to be refrigerated before it's reconstituted (see below). This should be an advantage during distribution. What's more, Xeomin has no additives — just botulinum toxin type A. This may lessen a patient's likelihood of developing antibodies.

Supposedly, Xeomin is more like Botox than Dysport. It takes about one week for the full effects of Xeomin injections to be realized, and once this occurs the results last from three to six months. Dysport, Xeomin and Botox should not be used interchangeably.

Also, since Xeomin is approved only for cervical dystonia and blepharospasm in adults who have had previous treatments with onabotulinumtoxinA (Botox), any use for wrinkles and crows feet is going to be off label. This, along with the fact that Botox pretty much owns this space will probably mean that Xeomin will have a hard slog finding a huge audience. It may be worth trying thought to see if you just like it that much better. (Anyone who's already tried it, please leave a comment and let us know what you think.)

Storage

Unopened vials of XEOMIN® (incobotulinumtoxinA) can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C ( 4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN® (incobotulinumtoxinA) should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.

Indications & Usage

Cervical Dystonia: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-naïve and previously treated patients.

Blepharospasm: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).

Complications

Like other botulinum products, Xeomin must carry a black box warning regarding a rare risk for spreading outside of the injection site. If this occurs, life-threatening swallowing and breathing problems may result. This has not been seen in people receiving neurotoxins for cosmetic reasons or to treat blepharospams. It has mainly occurred among children treated off-label for cerebral palsy-related muscle spasms.

Adverse Reactions

Cervical Dystonia: The most commonly observed adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN 120 Units and XEOMIN 240 Units, respectively, were: dysphagia (13%, 18%), neck pain (7%, 15%), muscle weakness (7%, 11%), and musculoskeletal pain (7%, 4%).

Blepharospasm: The most common adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN were eyelid ptosis (19%), dry mouth (16%), visual impairment (12%), diarrhea (8%), and headache (7%).

Drug Interactions

Concomitant treatment of XEOMIN and aminoglycoside antibiotics, spectinomycin, or other agents that interfere with neuromuscular transmission (e.g., tubocurarine-like agents), or muscle relaxants, should be observed closely because the effect of XEOMIN may be potentiated.

Pregnancy

Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Cost

The costs are expected to be similar to Botox. I checked over on Medical Spa RX and they don't seem to be carrying it as of now so you won't be able get a deal on it the way you can with Rx's Botox Group Buy Program.

Have you got any intention of trying something besides Botox or Dysport? Does Xeomin have a chance in your clinic? Would you try it on a few patients to see if you like it?

Reader Comments (20)

I met up with the CEO of Merz Pharmaceutical a few weeks ago on the Radiesse / Xeomen product lunch dinner at a fancy hotel. Everyone was very excited at Xeomen saying that it would destroy its competitors. The claim of no protein additive and no antibody effect is Xeomen's major breakthrough. Merz reps calims that dysport and botox users develop antibody reaction and end up using more products to counter the immune system's reaction to repeated exposure to botox / dysport products. Merz is also releasing its own brand of Hyaluronic Acid filler later this year. The Injection market will be very competitive in the future.

Interesting, but IMHO there's no way that Xeomin is going to 'destroy' Botox or even Dysport. With the entrenched marketing that Botox already has, I can't see that any Merz claims about no antibody effect is going to make an impact without some dramatic demonstrations. Patients don't know Xeomin from a hole-in-the-wall and while I'm sure I could suggest Xeomin to some clients and they'd bite on my recommendation, I don't know that I'd want to. Evidently there's not going to be any price savings and any new product is going to receive added scrutiny that isn't leveled at good 'ole Botox.

Any thoughts from someone who has already used Xeomin?

08.3 | Unregistered CommenterDermgal

The only way that Xeomin is going to gain significant market share is to be half the price of Botox and Dysport. I have been doing Botox for 8 years and I have the largest Botox practice in my region and feel I have only seen 2 true antibody reactions to Botox and by the way they did not do any better with Dysport. I have had over 1000 Botox patients and 2 episodes of antibody reaction. She this equals about 0.2% which is not much of a market share. So unitl they drop there price significantly I will not even give it a try.

Lornell E. Hansen II, M.D.
LazaDerm Skincare Centre
www.LazaDerm.com

08.3 | Unregistered CommenterLH

I'm with LH on this. I think that Xeomin is just too late to the party to make any inroads while Allergan and Botox are pounding on them. It's always the way that new products that are trying to break in to the cosmetic market seem to come up with some little benefit that they try to blow completely out of proportion. The truth is that Botox works and it will take more than a tiny percentage of patients that my have antibody reactions to make a dent. It just doesn't make sense to try and switch.

Still, I like to think that I'm open. If anyone has real experience I'd love to hear what they think.

08.3 | Unregistered CommenterFat MD

Allergan has established a solid standard in this country. Dysport remains well behind although the initial expectations were high. Xeomin has entered the market and only time will show the acceptance among the physicians.
Despite many claims, there is no real difference between Botox and other neurotoxins. This was established clearly by comparying Vistabel, Azzalure and Bocouture. The diffusion was identical when product was used in comparable dilutions and doses. The claim of residual protein content in some brands appeared to be only of academic meaning since in physiological pH these are immediately neutralized.
Personally, I think that once Merz receives the expected blessings from FDA for their HA fillers, it may become the most competitive alternative to Allergan offering Radiesse, Belotero HA line (with 1cc syringes) and neurotoxin. And why not?

I'm in complete agreement with Dr. Kacki. Steven Gallomp MD has a comparison of all of the products in Practical Neurology here in a paper titled Neurotoxin Therapy: A Closer Look At The Four Options here: http://bmctoday.net/practicalneurology/2011/04/article.asp?f=neurotoxin-therapy-a-closer-look-at-the-four-options

"Currently, there are four preparations of botulinum toxin available in the US, three for botulinum toxin type A and one for botulinum toxin type B. The type A serotype is available as onabotulinumtoxinA (Botox, Allergan), abobotulinumtoxinA (Dysport, Ipsen and Medicis for cosmetic use), and incobotulinumtoxinA (Xeomin, Merz), while the type B serotype is available as rimabotulinumtoxinB (Myobloc, Solstice Medical)."

Making Comparisons
Botulinum neurotoxin A is exceptionally effective in the therapy of a vast array of conditions. Now that there are three preparations of this serotype on the market, physicians must be familiar with the perceived, actual, and potential differences between these pharmacologically distinct agents. In reality, the clinical consequences of differences in molecular weight, protein content, and diffusion are probably negligible. Dosing and cost are likely the main differences between the preparations. Costs and insurance restrictions may drive selection of a preparation for a given patient, suggesting that clinicians may need to be comfortable with more than one preparation.

Botulinum neurotoxin type B largely remains a second- line option for the rare patient who demonstrates clinical resistance to serotype A therapy.

Another flash in the pan.. I would guess that Xeomin would actually take market share from Dysport more than Botox.

08.16 | Unregistered CommenterBotox Doc

Just met with Merz rep this week regarding Xeomin. Since we are his largest user of Radiesse, we were "chosen" to role out Xeomin 11/1. They are selling 100 unit vials for $425 but then you get 1 free (the next month) for every one you buy (so essentially $225 vial) There also are 2 $50 Visa gift cards you get per vial to distribute to your patients. They can redeem only at medical offices so it's encouraged that they use them back at your office their next visit. We will give it a try if only to drum up new business. If we discount it, we can get more people in the door. We normally charge $12/unit for Botox (often discount to $10) so I think we'd start Xeomin at $8/unit. Whether people stick with it or not will be the question. FYI - Our Allergan rep is not happy

wow , this is a great news.
I think there should be more competition among the suppliers. This way we are not over charged, ultimately the patients will be happier. Way to go Merz!

10.28 | Unregistered Commenteriti

I have decided not to bring in a new product to my office unless it is a significantly discounted. I've been using botox for over 6 yrs and recently brought in dypsort. the savings is not much but now i have to carry two products. Xeomin has to be discounted significantly (not just for a few months as the rep told me).

Also just started carrying Xeomin and have same deal as other Radiesse user. The product will be $100 cheaper per vial even without the current promotion. I'm glad Allergan has some competition and the badmouthing by the Allergan rep has already started as well as the incentive to patients to use Botox($50 rebate). I also will be letting my patients decide as they did with Dysport(preferred Botox). The great advantage to Xeomin vs Dysport is that reconstitution and dosing are same and price is truly cheaper. Patients done so far all noticed a "tight" feeling with injection. I"ll keep you posted.

11.8 | Unregistered Commentervb

There could be many reasons for the effect you are describing. However, it is impossible to make any judgement based on one... or five examples. The same argument could be used for any available neurotoxin .
I think that the majority of aesthetic practitioners will use what they are comfortable with and what they are most familiar with. The most important is, however, that we have now much greater choice than just few short years ago (in US).

After using Xeomin for several months I have had mixed results. One patient had great relaxation of her glabellar complex with 22 units after 2 weeks but at 4 weeks was moving 75% of original. Several patients have come back for extra units when they were treated with the same amount of xeomin as they had previously received with Botox. If the price stays only $100 less per vial, we probably won't be keeping it because patients would be better off with their Botox rebate and points (especially if they end up needing more units than with Botox).

Xeomin has now been pulled from the market. Last week Allergan won a lawsuit against Merz and Xeomin sales have been suspended for at least 10 months. I suspect this will be the "kiss of death" for them because it wasn't that great to begin with!

I didn't realize that we cannot get Radiesse also? I thought it was only about the Xeomin. This is horrible.

04.21 | Unregistered Commenterfiller md

My experience is that the Xeomin lasts 2/3 the length of Botox . We stopped using it before it was pulled.

Xeomin has been pulled off the US Market and new accounts are not even able to order radiesse.
Not really sure if xeomin will come back or not.
So now its Dysport X Botox! Not sure we need another 'guy' in the market. Patients get confused enough as it is.

During AAD Meeting in San Diego there were signs all over and only the international folks were at their booth. Sign that something is not right.......

Xeomin most certainly will be available. Radiesse is as available now as it was before court injunction.
There are many unsubstantiated claims and statements in some communities. The problem is not the product but quite common tactics used to delay market sharing and lowering price of the product. Its not complicated; there is no conspiracy. Sorry...;)

Xeomin sucks. It was not strong enough and after a month I had new wrinkles and crows feet I've never seen before. It seemed to bunch up under eyes. I just don't think it's a good product. Gone after a month.

06.21 | Unregistered CommenterLeigh

I was never a fan of Xeomin finding that it consistently had a duration of action below that of Botox or Dysport. I have been using botox since 1990 and started using Dysport heavily about 3 years ago.

06.22 | Unregistered Commentergm

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