Five‐year experience with incobotulinumtoxinA (Xeomin®): the first botulinum toxin drug free of complexing proteins

In 2005, incobotulinumtoxinA (Xeomin^®), a new botulinum toxin (BT) type A drug without complexing proteins (CPs), became available. This paper reviews the specific features of Xeomin^® and the experience gathered with it during the last 5 years. Compared with conventional BT drugs, Xeomin^®’s extended shelf live and its simplified temperature restrictions indicate that CPs are not necessary for BT drug stability. Its reduced molecular size does not translate into diffusion differences, and its potency labelling is identical to that of onabotulinumtoxinA (Botox^®). With a reduced content of inactivated botulinum neurotoxin, Xeomin^® should have reduced antigenicity. Lack of CP’s may further reduce antigenicity. Xeomin^®’s therapeutic efficacy against cervical dystonia, blepharospasm and spasticity has been proven in large randomised, double‐blind and placebo‐controlled studies leading to registrations in many countries. Additional successful clinical use in axillary hyperhidrosis, hemifacial spasm, re‐innervation synkinesias and hypersalivation as well as in dystonia and spasticity in extended doses and throughout extended observation periods has been documented meanwhile. Lack of reported cases of antibody‐induced therapy failure (ABF), as to date, support the hypothesis of an improved antigenicity.