Conversion Ratio between Botox®, Dysport®, and Xeomin® in Clinical Practice Francesco Scaglione 1 Affiliations expand PMID: 26959061 PMCID: PMC4810210 DOI: 10.3390/toxins8030065 Free PMC article


Botox has revolutionized the treatment of spasm and is now used all over the world. There are currently three major botulinum neurotoxin type A products in the Western Hemisphere: onabotulinum toxin-A (ONA) Botox(®), abobotulinum toxin-A (ABO), Dysport (®), and incobotulinum toxin A (INCO, Xeomin ( ® )). Although the efficacies are similar, there is an intense debate regarding the comparability of the different preparations. Here we will address clinical issues of potency and conversion ratios, as well as safety issues such as toxin dissemination and immunogenicity, to provide guidance for the use of BoNT-A in clinical practice. INCO was shown to be as effective as ONA with a comparable adverse event profile when a clinical conversion ratio of 1:1 was used. Available clinical and preclinical data suggest that an ABO:ONA conversion ratio of 3:1—or even lower—may be appropriate for the treatment of spasticity, cervical dystonia, and blepharospasm or hemifacial spasm. A higher conversion ratio can lead to an overdose of ABO. Although uncommon, distant spread can occur; however, several factors other than the pharmaceutical preparation are thought to influence proliferation. Finally, while all three products have similar efficacy when properly dosed, ABO has a better cost-effectiveness profile