Scaglione Francesco
Department of Oncology and Onco-Hematology, University of Milan, Via Vanvitelli 32, 20129 Milan, Italy.
Toxins (Basel). 2016 Mar 4;8(3):65. doi: 10.3390/toxins8030065.
Botulinum neurotoxin has revolutionized the treatment of spasticity and is now administered worldwide. There are currently three leading botulinum neurotoxin type A products available 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 various preparations. Here we will address the clinical issues of potency and conversion ratios, as well as safety issues such as toxin spread and immunogenicity, to provide guidance for BoNT-A use 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. The available clinical and preclinical data suggest that a conversion ratio ABO:ONA of 3:1-or even lower-could be appropriate for treating spasticity, cervical dystonia, and blepharospasm or hemifacial spasm. A higher conversion ratio may lead to an overdosing of ABO. While uncommon, distant spread may occur; however, several factors other than the pharmaceutical preparation are thought to affect spread. Finally, whereas the three products have similar efficacy when properly dosed, ABO has a better cost-efficacy profile.
肉毒杆菌神经毒素彻底改变了痉挛的治疗方法，目前在全球范围内都有应用。目前在西半球有三种主要的A型肉毒杆菌神经毒素产品：注射用A型肉毒毒素（ONA）保妥适（Botox®）、阿柏型肉毒毒素（ABO）、得保松（Dysport®）和因卡型肉毒毒素A（INCO，Xeomin®）。尽管它们的疗效相似，但关于各种制剂的可比性仍存在激烈争论。在此，我们将探讨效力和转换率的临床问题，以及毒素扩散和免疫原性等安全性问题，为临床实践中使用A型肉毒毒素提供指导。当采用1:1的临床转换率时，INCO显示出与ONA同样有效，且不良事件谱相当。现有临床和临床前数据表明，ABO与ONA的转换率为3:1甚至更低可能适用于治疗痉挛、颈部肌张力障碍以及眼睑痉挛或半面痉挛。较高的转换率可能导致ABO用药过量。虽然罕见，但可能会发生远处扩散；然而，人们认为除药物制剂外的其他几个因素会影响扩散。最后，虽然这三种产品在适当给药时疗效相似，但ABO具有更好的性价比。
