Clinical Equivalence of Conventional OnabotulinumtoxinA (900 KDa) and IncobotulinumtoxinA (Neurotoxin Free From Complexing Proteins – 150 KDa): 2013 Multidisciplinary French Consensus in Aesthetics
December 2013 | Volume 12 | Issue 12 | Original Article | 1434 | Copyright © December 2013
Bernard Poulain PhD,a Patrick Trevidic MD,b Micheline Clavé MD,c Claude Aharoni MD,d Martine
Baspeyras MD,e Patrick Bui MD,f Hugues Cartier MD,g Marie-Hélène Charavel MD,h Pierre Coulon MD,i
Serge Dahan MD,j Jean-Marie Dallara MD,k Denis Delonca MD,l Laurent Dumas MD,m
Eric Essayagh MD,n Olivier Galatoire MD,o Nicolas Georgieu MD,p Yann Grangier MD,q
Philippe Humbert PhD,r Anne Le Pillouer-Prost MD,s and Alain Mojallal MDt
aInstitute of Cellular and Integrative Neurosciences, CNRS, University of Strasbourg, Strasbourg, France
bRue de Sontay, Paris, France
cAvenue de Flirey, Nice, France
dClinique Esthétique de Paris Spontini, Paris, France
eCentre Bordelais Dermatologie Esthetique, Bordeaux, France
fRue du Champ de Mars, Paris, France
gSquare Saint Jean, Arras, France
hCentre Esthétique et Anti-Age Médico-Chirurgical Paramédical et Laser de Bordeaux Triangle, Bordeaux, France
iRue Michelet, Ales, France
jClinique Saint Jean-Languedoc, Toulouse, France
kCentre Laser Dermatologique Laser MD, Strasbourg, France
lClinique Esthétique Aquitaine, Bordeaux, France
mAvenue Carnot, Paris, France
nAvenue Saramartel, Antibes, France
oFondation Ophtalmologique Adolphe de Rothschild, Paris, France
p Chirurgie Plastique Reconstructrice et Esthetique, Bayonne, France
qClinique de l’Ocean, Quimper, France
rUniversity of Franche-Comte, Besançon, France
sService de Dermatologie, Hôpital Privé Clairval, Marseille, France
tEdouard Herriot Hospital, Lyon, France
Abstract
Botulinum neurotoxins are the most popular non-surgical treatments for aesthetic indications, but there is uncertainty about whether
certain formulations are comparable in efficacy and safety and can be substituted for one another by a simple one to one dose
conversion ratio. An expert panel of French practitioners was convened to establish a consensus on the clinical equivalence in efficacy
and safety of OnabotulinumtoxinA (900 KDa) and IncobotulinumtoxinA (neurotoxin free from complexing proteins - 150 KDa).
The consensus was divided into three sections incorporating a biological, bibliographic and clinical analysis of the two toxins. This
included a review of the published data that have directly compared the two toxins for aesthetic indications and a survey of the
panel's extensive clinical experience with the two toxins in terms of efficacy and safety. All panel members reviewed and endorsed
the content of each section. Among this expert panel of French aesthetic physicians and biologists there was consensus that OnabotulinumtoxinA
and IncobotulinumtoxinA are clinically equivalent in terms of efficacy and safety, and that a switch from one drug
to the other can be made using a simple 1:1 conversion ratio.
J Drugs Dermatol. 2013;12(12):1434-1446.
INTRODUCTION
The use of botulinum toxin as a therapeutic agent was
pioneered by an ophthalmologist around 30 years ago
for use in strabismus and blepharospasm.1,2 In the following
decades, botulinum toxin became the standard of care
for a number of disorders related to muscle dystonia. The potential
aesthetic indications for botulinum toxin first became
apparent in 1987, when it was found that treatment of blepharospasm
also resulted in a smooth and relaxed appearance of the
