A Direct Comparison of OnabotulinumtoxinA (Botox) and IncobotulinumtoxinA (Xeomin) in the Treatment of Benign Essential Blepharospasm: A Split-face Technique

Saad, Julien BSc, MD; Gourdeau, Alain MD, FRCSC

Journal of Neuro-Ophthalmology:
doi: 10.1097/WNO.0000000000000110
Original Contribution

Background: Benign essential blepharospasm (BEB) is characterized by progressive involuntary contractions of the protractor muscles, sometimes leading to a debilitating closure of the lids. It is currently treated with the injection of botulinum neurotoxin A (BoNT/A). The purpose of this study was to compare 2 BoNT/A preparations (i.e., Xeomin and Botox) in the treatment of BEB.

Methods: This was a prospective, randomized, double-blinded split-face technique in 48 patients already treated by Botox for BEB. Patients received the same medication to either side of the face for 4 injections, and were then evaluated using subjective and objective measures. Blepharospasm Disability Index (BSDI) and Jankovic Rating Scale (JRS) were assessed using a repeated-measures analysis of variance (ANOVA) and paired t test. Patient preference and objective comparison of residual orbicularis strength and spasm were compared using a multinomial logistic regression model, a repeated-measures ANOVA, and a paired t test.

Results: A paired t test showed no preference between Xeomin and Botox (P = 0.7205) and demonstrated a tendency toward not having a preference for either medication (P = 0.0301 vs Botox and P = 0.0039 vs Xeomin). The regression model showed no effect of time on patient preference (P = 0.4217). The ANOVA for BSDI scores did not reveal any difference between the 2 medications as compared with baseline (P = 0.8161), nor did it demonstrate an effect of time on BSDI scores (P = 0.6108). A paired t test found no difference between the 2 scores (P = 0.1909) at baseline. There was no difference in JRS scores for either medication when compared with baseline (P = 0.2314), nor was there an effect of time on such scores (P = 0.4951). There was also no difference between the 2 medications according to paired t test (P = 0.3224) at baseline. Baseline residual orbicularis strength was similar between the 2 medications (paired t test; P = 0.3228). ANOVA shows an effect of time on orbicularis strength (P = 0.0055), but no difference was seen at any of the 5 visits (P > 0.05). Baseline spasm scores were similar between Botox and Xeomin (paired Student t test; P = 0.3228). The ANOVA shows no difference between both medications at any point in time (P = 0.4408), and that time had no effect on the efficacy of either treatment (P = 0.3268).

Conclusion: No difference between Xeomin and Botox was detected in either subjective or objective measures for the treatment of BEB.

Author Information

Département d'ophtalmologie (JS, AG), Faculté de médecine, Université Laval, Quebec City, Canada; and Centre universitaire d'ophtalmologie et Centre de recherche du CHU de Québec (JS, AG), Hôpital de l'Enfant-Jésus, Quebec City, Canada.

Address correspondence to Julien Saad, BSc, MD, Hôpital Saint-Sacrement, 1050 chemin Ste-Foy, Quebec, QC, G1S 4L8, E-mail: julien.saad@gmail.com

Supported by research funds provided by Centre universitaire d'ophtalmologie, CHU de Québec, Quebec, Canada.

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society