Table 1.
Comparison of FDA-approved Botulinum Toxin (BoNT) Formulations in the United States
| Trade Name (Proprietary Name) | Manufacturer | Serotype | Form | Onset of Action | Length of Therapeutic Effect | Units per Vial | Molecular Weight | Excipients (Per Vial) | Cost Per Unit * | Year of FDA Approval | FDA Approved Indications |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Botox (OnabotulinumtoxinA) | Allergan Inc., Irvine, Calif. | A | Powder | 3–5 d (up to 2 wk) | 3–6 mo | 50 or 100 | 900 kDa | HSA (0. 5 mg) NaCl (0.9 mg) |
Generally most expensive. Ranges from $10–20 per unit in the United States. |
1989 | Blepharospasm hemifacial spasm strabismus Cervical dystonia, migraines Upper limb spasticity, lower limb spasticity, neurogenic detrusor overactivity Overactive bladder, forehead lines and wrinkles |
| Dysport (AbobotulinumtoxinA) | Ipsen Limited, Berkshire (UK) | A | Powder | Within 24 h | 3–6 mo | 300 or 500 | 500–900 kDa | HSA (0.125 mg) Lactose (2.5 mg) |
Generally least expensive. Ranges from $4–8 per unit in the United States. |
2009 | Cervical dystonia Frown lines and wrinkles Upper limb spasticity Lower limb spasticity |
| Xeomin (IncobotulinumtoxinA) | Merz Pharmaceuticals GmbH, Frankfurt am Main (Germany) | A | Powder | 5–7 d | 3–6 mo | 100 | 150 kDa | HSA (1.0 mg) Sucrose (5 mg) |
Slightly less than Botox. Ranges from $8–18 per unit in the United States. |
2010 | Cervical dystonia Blepharospasm Frown lines Upper limb spasticity Sialorrhea |
| Jeuveau (PrabotulinumtoxinA) | Daewoong Pharmaceuticals (South Korea) | A | Powder | 3–5 d | 3–6 mo | 50 or 100 | 900 kDa | HSA (0.5 mg) NaCl (0.9 mg) |
Same or slightly less than Botox. Ranges from $8–16 per unit in the United States. |
2019 | Glabellar Lines |
| Myobloc/ Neurobloc (RimabotulinumtoxinB) | Solstice Neurosciences Inc., South San Francisco, CA, (USA) | B | Solution | 3–5 d (up to 2 wk) | 3–6 mo | 2500, 5000, or 10,000 | 700 kDa | HSA (0.5 mg) NaCl (5.844 mg) Sodium succinate (1.621 mg) |
Variable. | 2009 | Cervical Dystonia Sialorrhea |
Of note, Myobloc is the brand name in the United States, Canada, and Korea, whereas Neurobloc is the brand name in the European Union, Norway, and Iceland. Dysport has the fastest time to onset of action, and in general, all BoNT have approximately the same length of therapeutic effect. The average cost of BoNT injections vary depending on severity of the condition, amount of product used, expertise and qualifications of injector, and the geographic office location. Thus, trends on the costs of BoNT have been identified, with Botox typically being the most expensive per unit for treatment of common fine lines and wrinkles, whereas Dysport is the cheapest neuromodulator but more units are typically required to have the same effect.
HSA, human serum albumin; NaCl, sodium chloride.