PrabotulinumtoxinA Vs OnabotulinumtoxinA

As an early UK adopter of prabotulinumtoxin A, Yorkshire Skin Centre’s Dr Raj Thethi compares the innovative injectable with the long-established onabotulinumtoxinA

The landscape of aesthetic medicine is continually expanding, largely due to emerging innovative products seeking to cater to the ever-evolving needs and demands of patients. In this article, I will compare two key figures in the world of neuromodulators: the long-established onabotulinumtoxinA (Botox®) and the innovative prabotulinumtoxinA (Nuceiva). By examining the strengths and limitations of both products, an attempt is made to provide a comprehensive picture of the current and future landscape of neuromodulators.

ONABOTULINUMTOXINA: A LEGACY OF SUCCESS

OnabotulinumtoxinA has been a key player in the aesthetic medicine industry for decades. Celebrated for its effectiveness and versatility, its wide-ranging field of effect has opened a myriad of treatment possibilities, contributing to its recognised place in the industry. However, there is an established field of diffusion and, with that, a potential risk of unintended impact on surrounding muscles, causing undesirable effects in certain cases.

PRABOTULINUMTOXINA: A RISING STAR

Emerging on the scene, prabotulinumtoxinA (commercially known as Nuceiva) offers new possibilities. Crucially, the toxin’s state-of-the-art manufacturing presents a well-documented >95% purity. Nuceiva® has been clinically noted to provide a tight field of effect which translates to how it diffuses into surrounding areas upon administration, potentially mitigating the risk of unintended side effects.

COMPARATIVE CLINICAL TRIALS: A DEEP DIVE

In assessing the toxin’s relative performance, comprehensive consideration of the multiple clinical trials held across the US, Canada, and Europe, is essential. These trials included doubleblinded, randomised, head-to-head comparisons, and presented robust evidence of prabotulinumtoxinA’s effectiveness. Notably, prabotulinumtoxinA matched or numerically outperformed onabotulinumtoxinA in a striking 26 out of 30 monitored data points, highlighting its competitive edge and promising potential.

THE PROS AND CONS

While Botox® offers a long-standing legacy and has been the go-to treatment for many years, it is also known to have a specific diffusion profile which can lead to unwanted effects. On the other hand, Nuceiva, with its clinically observed tight field of effect, presents potential advantages such as a reduction in the risk of unwanted side effects, pinpoint precision, and improved patient satisfaction.

However, it’s important to note, as a new player in the market, Nuceiva lacks the vast number of real-world, long-term patient experiences that Botox® has acquired over decades of use. Though Nuceiva® has been licensed in the USA market as Jeuveau® for the last four years, it will take many decades for the number of treatments to compare with its long-standing predecessor. It is also crucial for practitioners to become adept at handling Nuceiva®’s unique characteristics, to effectively leverage its advantages and minimise any potential downsides.

As its noted to have a tight field of effect that means product placement needs to be more accurate and intramuscular to yield its full potential. Nuceiva® is licensed in the UK for the glabella only currently. This has traditionally been the case with all new toxins that come on to the market so we will need to wait for emerging licenses in the future to discuss the nuances of different treatment areas later.

FUTURE IMPLICATIONS: THE UK LANDSCAPE

As the neuromodulator market continues to develop in the UK, the emergence of new, innovative products such as Nuceiva® will undoubtedly shape its future trajectory. Based on the comparative clinical trials, the millennial and Gen Z interest in brands that resonate with their values, and the impressive qualities of Nuceiva, we can anticipate an increase in its adoption. As with any new product, ongoing research and real-world experience will be vital in further establishing its place in the industry.

CONCLUSION

The world of aesthetic medicine, particularly in the UK, stands at an exciting juncture with the introduction of Nuceiva, a neuromodulator with promising clinical trial results, an impressive purity profile, and a favourable field of effect. Evolus, the innovative company behind Nuceiva, resonates with the fresh perspectives and preferences of millennials and Generation Z, making it a powerful contender in this evolving industry.

While Botox® has paved the way, creating a solid foundation for the use of neuromodulators in aesthetic medicine, the emergence of Nuceiva® signifies a promising evolution in this field. It underscores the value of continuous innovation, highlighting the potential for improved patient outcomes and satisfaction.

DR RAJ THETHI

Dr Raj Thethi MBChB BSc(Hons) MRCSEd is a member of the Aesthetic Medicine editorial board and an aligned advocate of Evolus. Having used onabotulinumtoxinA (Botox®) in his clinic for the previous six years, he was given the opportunity to trial prabotulinumtoxinA (Nuceiva) in October 2022 and became an early adopter of the product in the UK. He has since used Nuceiva almost solely and has treated more than 600 patients in his clinic, the Yorkshire Skin Centre.