Botox From Asia

Botox has been used to treat neuromuscular diseases and been a prevalent filler in the realm of aesthetic medicine for a long time. There have been so many companies developing their own neotoxin formula for botox injections available in the market, but which is the correct one to choose? 

Typically, an injector should use a neurotoxin that is less immunogenic with highly purified toxins to obtain successful results for long-term repeated treatments. If there is a significant level of immunogenic response, this can lead to the formation of antibodies that can decrease the interaction between botox and presynaptic membrane binding sites. We want the interaction between botox and its presynaptic membrane binding site to have as little hindrance as possible so we can have the ideal results of relaxing the facial muscles, reducing wrinkles or frown lines.

New Toxin Formulations from Asia

New toxin formulations have recently emerged in Asia that created hype around these products. The new formulas in question are:

• Botulax (Seoul, South Korea)
• Meditoxin/neuronox (Seoul, South Korea)
• Nabota (Seoul, South Korea)
• Relatox (Microgen, Russia)

However, information regarding these neurotoxins' purity, the impact of their dose on efficacy, or adverse events have been limited. In order to find out these key details, these products are compared with Xeomin as the control because it is one of the only purified forms of botulinum toxin type A (naked neurotoxin).

How Do These Products Compare With Xeomin

These neurotoxins were measured in terms of amount of neurotoxin protein per 100 units, specific potency, and proportion of inactive neurotoxins. These were the findings:

Amount of Neurotoxins per 100 units

• Botulax: 844 ± 43
• Meditoxin/neuronox: 575 ± 6
• Nabota: 754 ± 11
• Relatox: 578 ± 48
• Xeomin: 416 ± 6

Specific potency

• Botulax: 0.118
• Meditoxin/neuronox: 0.174
• Nabota: 0.133
• Relatox: 0.173
• Xeomin: 0.240

Proportion of inactive neurotoxins

• Botulax: 103
• Meditoxin/neuronox: 38
• Nabota: 81
• Relatox: 33
• Xeomin: Not found   

Why Is This Comparison Significant?

Based on the findings, it is concluded that the four neurotoxin formulations being used in Asia demonstrated lower neurotoxin purity and specific potency but higher neurotoxin protein concentrations than Xeomin. Although these four formulas have greater amounts of neurotoxin present per 100 units, they both also show a greater amount of inactive neurotoxins. 

It is also noted that these products all contained the botulinum toxin complex with about sixfold more additional bacterial proteins (in comparison with Xeomin, which consists solely of neurotoxin and free of complexing proteins). These complex proteins have a higher potential to cause an immune response because they can bind to dendritic cells of the immune system to activate it. The formation of antibodies in patients treated with complex protein-containing products creates less interaction between the botox and the body, causing the therapy to fail (antibody formation was not observed in patients treated with Xeomin). As mentioned previously, the less immunogenic the toxin is, the greater the effect will be. 

Therefore, it is very important for new neurotoxin products released into the market to undergo a comparative study on the efficacy, effective duration, and safety profile of all neurotoxin products. It is also important for injectors to research the products intended to use on their patients. Do not trust everything marketing to you at face value.