From the FDA Drug Label
5 WARNINGS AND PRECAUTIONS
- 2 Lack of Interchangeability between Botulinum Toxin Products The potency Units of JEUVEAU are specific to the preparation and assay method utilized They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of JEUVEAU cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method
The FDA drug label does not answer the question.
From the Research
Higher doses or more frequent administration of botulinum toxin can lead to reduced efficacy due to antibody formation, and clinicians should use the lowest effective dose and maintain at least 12-week intervals between treatments to minimize this risk. The risk of developing neutralizing antibodies is particularly elevated with higher protein load formulations and in patients receiving higher cumulative doses for conditions like cervical dystonia or spasticity (typically >300 units of onabotulinumtoxinA per session) 1. According to a recent study published in 2024, the median number of injections per year was 2, with the median weeks between injections being between 13 and 15, which suggests that maintaining a 12-week interval between treatments may be a common practice 1.
The immunogenicity of botulinum toxin occurs because it is a foreign protein that can trigger an immune response, especially with repeated exposure 2. Once antibodies develop, patients may require alternative treatments as the resistance is often permanent. A study from 1993 found that chronic treatment with botulinum toxin in patients with blepharospasm and cervical dystonia is not associated with any decline in benefit, and that efficacy may improve slightly with repeat treatments 3. However, this study did not specifically address the issue of antibody formation and reduced efficacy.
In terms of patient characteristics and real-world use of botulinum toxins, a study from 2024 found that patients with cervical dystonia, blepharospasm, and hemifacial spasm were commonly females and aged 45 and older, and that anticholinergics and peripheral muscle relaxants were commonly used in conjunction with botulinum toxin injections 1. The study also found that dyspnea was a common adverse event across all cohorts, highlighting the need for careful monitoring and management of patients receiving botulinum toxin injections.
Overall, the evidence suggests that higher doses or more frequent administration of botulinum toxin can lead to reduced efficacy due to antibody formation, and that clinicians should use the lowest effective dose and maintain at least 12-week intervals between treatments to minimize this risk.
Key points to consider:
- Use the lowest effective dose of botulinum toxin to minimize the risk of antibody formation
- Maintain at least 12-week intervals between treatments to reduce the risk of reduced efficacy
- Monitor patients for signs of antibody formation and reduced efficacy, such as decreased response to treatment or increased adverse events
- Consider switching between different serotypes of botulinum toxin if resistance develops
- Be aware of the potential for adverse events, such as dyspnea, and take steps to minimize their occurrence.