CATEGORY 56 AUSTRALASIAN DENTIST Nuceiva vs Xeomin: Two outstanding toxins, two different approaches CLINICAL Dr Giulia D’Anna By Dr Giulia D'Anna BDSc, MRACDS, FIADFE When it comes to choosing a botulinum toxin type A for your patients, the decision rarely comes down to efficacy alone. Both Nuceiva (prabotulinumtoxinA-xvfs, Evolus) and Xeomin (incobotulinumtoxinA, Merz) are excellent neuromodulators with strong clinical track records, comparable unit dosing to onabotulinumtoxinA, and wellcharacterised safety profiles. But they achieve their results through meaningfully different formulation strategies – and understanding those differences helps practitioners make more informed, patientspecific decisions. Both products are available through the Dermal Distinction Academy store at competitive pricing, so this comparison is genuinely relevant to your clinical practice. On-Label Indications In Australia, both Nuceiva and Xeomin hold TGA approval for the treatment of glabellar lines – the vertical frown lines between the brows. This is the primary on-label cosmetic indication, and it aligns with the approved indications in most international markets where these products are registered. Xeomin carries broader therapeutic approvals in several markets, including cervical dystonia and blepharospasm, reflecting its longer regulatory history. This broader therapeutic dataset also contributes to the depth of long-term safety data available for the product. While the cosmetic injector's dayto-day use of both products sits within the glabellar indication, it is worth appreciating that Xeomin's therapeutic track record adds another layer of characterisation to its clinical profile. Both products are used extensively off-label for a wide range of indications – masseters, temporalis, platysma, depressor anguli oris, and more – consistent with accepted practice standards and the evidence base for botulinum toxin use in aesthetic medicine. Formulation: Freeze-drying Vs vacuum-drying This is one of the more practically interesting differences between the two products. Xeomin undergoes traditional freeze-drying (lyophilisation), a wellestablished pharmaceutical process that removes water under frozen conditions to produce a stable, shelf-stable powder. The resulting vial contains only the active 150-kDa neurotoxin – more on that shortly – in a lyophilised form that is reconstituted with normal saline prior to injection. Nuceiva, developed by Daewoong Pharmaceutical in South Korea and commercialised by Evolus, uses a vacuum-drying process rather than conventional freezedrying. In this method, moisture is removed under vacuum at controlled temperatures, producing a stable, uniform powder with a high degree of purity. Daewoong's manufacturing process reflects significant investment in precision biotechnology, and the resulting product has demonstrated consistency and stability across the large-scale clinical trials of the SAKURA program. Carruthers et al. (2017, Dermatol Surg) and Bertucci et al. (2018, Dermatol Surg) both confirmed product consistency and reliability across the SAKURA 1 and SAKURA 2 Phase 3 trials, which enrolled patients across multiple international centres. Both processes produce a stable, highquality product. The formulation difference is relevant mainly in understanding how each product came to be – and for those who are curious about the science behind what they are injecting. Immunogenicity: Different mechanisms, comparable outcomes Repeated exposure to botulinum toxin can, in some circumstances, lead to antibodies SINCE 1989
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