{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:01:17Z","timestamp":1777676477613,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>This retrospective study investigates botulinum toxin changes in 206 patients with spasticity, following reimbursement adjustments in France. The main objective was to evaluate the tolerance and efficacy of these changes, a topic underexplored due to the common practice of maintaining the same toxin brand. The majority of patients switched from Botox to Xeomin (73.66%), while others switched from Botox to Dysport (14.63%) or from Xeomin to Dysport (11.71%). Dose adjustments varied depending on the switch, with the change from Botox to Xeomin showing the greatest diversity in adjustments. Overall, tolerance was good, with few adverse effects reported, primarily fatigue. Perceived efficacy fluctuated, with some patients noting improvement while others experienced deterioration, but the median remained stable. A majority of patients (57.06%) chose to continue with their new treatment, indicating general satisfaction, though 42.93% preferred to return to their initial treatment. This study highlights the importance of an individualized approach and careful monitoring during toxin changes. The results suggest that toxin switches can be made without an increase in adverse effects. While differences between groups were observed, they were not statistically significant. Placebo and nocebo effects may influence perceptions of efficacy and side effects during treatment changes.<\/jats:p>","DOI":"10.3390\/toxins17030103","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:36:47Z","timestamp":1740375407000},"page":"103","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Switox: Retrospective Analysis of Botulinum Toxin Switching in Management of Spasticity"],"prefix":"10.3390","volume":"17","author":[{"given":"Emilie","family":"Leblong","sequence":"first","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3926-2855","authenticated-orcid":false,"given":"Patrice","family":"Piette","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Anne","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maud","family":"Jeanne","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marion","family":"Poyau","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne Laure","family":"Roy","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Gallien","sequence":"additional","affiliation":[{"name":"Fondation Saint Helier, 35043 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.rehab.2018.08.004","article-title":"Adjuvant treatments associated with botulinum toxin injection for managing spasticity: An overview of the literature","volume":"62","author":"Picelli","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"jrm4257","DOI":"10.2340\/jrm.v55.4257","article-title":"Clinical presentation of patients with lower limb spasticity undergoing routine treatment with botulinum toxin: Baseline findings from an international observational study","volume":"55","author":"Esquenazi","year":"2023","journal-title":"J. Rehabil. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sun, L.C., Chen, R., Fu, C., Chen, Y., Wu, Q., Chen, R., Lin, X., and Luo, S. (2019). Efficacy and safety of botulinum toxin type a for limb spasticity after stroke: A Meta-analysis of randomized controlled trials. BioMed Res. Int., 2019.","DOI":"10.1155\/2019\/8329306"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Faccioli, S., Cavalagli, A., Falocci, N., Mangano, G., Sanfilippo, I., and Sassi, S. (2023). Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: A systematic review and meta-analysis. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1256392"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104682","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104682","article-title":"Botulinum Toxin Type A for Upper Limb Spasticity in Poststroke Patients: A Meta-analysis of Randomized Controlled Trials","volume":"29","author":"Jia","year":"2020","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"249","DOI":"10.3390\/toxins5020249","article-title":"Long-term efficacy and safety of botulinum toxin injections in dystonia","volume":"5","author":"Jankovic","year":"2013","journal-title":"Toxins"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8160","DOI":"10.12659\/MSM.911296","article-title":"Efficacy and Safety of Botulinum Toxin Type A in Spasticity Caused by Spinal Cord Injury: A Randomized, Controlled Trial","volume":"24","author":"Yan","year":"2018","journal-title":"Med. Sci. Monit."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"158","DOI":"10.5603\/PJNNS.a2021.0032","article-title":"Safety and efficacy of Botulinum toxin type A preparations in cerebral palsy\u2014An evidence-based review","volume":"55","author":"Bonikowski","year":"2021","journal-title":"Neurol. Neurochir. Pol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1007\/s10072-017-3078-3","article-title":"Determinants of botulinum toxin discontinuation in multiple sclerosis: A retrospective study","volume":"38","author":"Latino","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"86","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_11","first-page":"694","article-title":"Une toxine botulique de type A modulaire et non pathog\u00e8ne [A modular and non pathogenic type A botulinum toxin]","volume":"27","author":"Darios","year":"2011","journal-title":"Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2165\/11584780-000000000-00000","article-title":"Content of botulinum neurotoxin in Botox\u00ae\/Vistabel\u00ae, Dysport\u00ae\/Azzalure\u00ae, and Xeomin\u00ae\/Bocouture\u00ae","volume":"10","author":"Frevert","year":"2010","journal-title":"Drugs R&D"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Scaglione, F. (2016). Conversion Ratio between Botox\u00ae, Dysport\u00ae, and Xeomin\u00ae in Clinical Practice. Toxins, 8.","DOI":"10.3390\/toxins8030065"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1212\/01.WNL.0000163767.99354.C3","article-title":"A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia","volume":"64","author":"Benecke","year":"2005","journal-title":"Neurology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00702-005-0323-3","article-title":"Efficacy and safety of a new Botulinum Toxin Type A free of complexing proteins in the treatment of blepharospasm","volume":"113","author":"Jost","year":"2006","journal-title":"J. Neural Transm."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1007\/s00415-012-6510-x","article-title":"Botulinum toxin as treatment for focal dystonia: A systematic review of the pharmaco-therapeutic and pharmaco-economic value","volume":"259","author":"Zoons","year":"2012","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/jnnp.59.1.102","article-title":"Dose standardisation of botulinum toxin","volume":"59","author":"Marion","year":"1995","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_18","first-page":"382","article-title":"Comparison of dosage effects between the American and British botulinum toxin A product in the treatment of spasmodic dysphonia","volume":"10","author":"Whurr","year":"1995","journal-title":"Mov. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s00702-010-0409-4","article-title":"Hemifacial spasm and reinnervation synkinesias: Long-term treatment with either Botox or Dysport","volume":"117","author":"Kollewe","year":"2010","journal-title":"J. Neural Transm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1007\/s00415-008-0031-7","article-title":"Biological activity of two botulinum toxin type A complexes (Dysport\u00ae and Botox\u00ae) in volunteers: A double-blind, randomized, dose-ranging study","volume":"255","author":"Wohlfarth","year":"2008","journal-title":"J. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1179\/174313209X405137","article-title":"A long-term follow-up of botulinum toxin A in cervical dystonia","volume":"31","author":"Mohammadi","year":"2009","journal-title":"Neurol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/WNF.0b013e3182711fc0","article-title":"Clinical experience of dose conversion ratios between 2 botulinum toxin products in the treatment of cervical dystonia","volume":"35","author":"Rystedt","year":"2012","journal-title":"Clin. Neuropharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/mds.870120627","article-title":"DYSBOT: A single-blind, randomized parallel study to determine whether any differences can be detected in the efficacy and tolerability of two formulations of botulinum toxin type A--Dysport and Botox--assuming a ratio of 4:1","volume":"12","author":"Sampaio","year":"1997","journal-title":"Mov. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/BF00941758","article-title":"Comparison of two botulinum-toxin preparations in the treatment of essential blepharospasm","volume":"235","year":"1997","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s10072-011-0672-7","article-title":"Retrospective evaluation of the dose equivalence of Botox\u00ae and Dysport\u00ae in the management of blepharospasm and hemifacial spasm: A novel paradigm for a never ending story","volume":"33","author":"Bentivoglio","year":"2012","journal-title":"Neurol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1468-1331.2006.01649.x","article-title":"Using translational medicine to understand clinical differences between botulinum toxin formulations","volume":"13","author":"Aoki","year":"2006","journal-title":"Eur. J. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/PL00004951","article-title":"Botulinum A toxins: Units versus units","volume":"355","author":"Wohlfarth","year":"1997","journal-title":"Arch. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1002\/mds.20468","article-title":"Retrospective evaluation of the dose of Dysport and BOTOX in the management of cervical dystonia and blepharospasm: The REAL DOSE study","volume":"20","author":"Marchetti","year":"2005","journal-title":"Mov. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.3390\/toxins7051629","article-title":"Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy","volume":"7","author":"Strobl","year":"2015","journal-title":"Toxins"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.bjoms.2022.11.279","article-title":"Botulinum toxin in the management of myalgia in temporomandibular disorders: Are all injections equal?","volume":"61","author":"Anwar","year":"2023","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_31","unstructured":"(2025, January 25). PharmaMedicale. Botulinum Toxin. Published 2017. Available online: https:\/\/pharmacomedicale.org\/medicaments\/par-specialites\/item\/toxine-botulique."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1185\/030079905X36396","article-title":"Safety, effectiveness, and duration of effect of BOTOX after switching from Dysport for blepharospasm, cervical dystonia, and hemifacial spasm","volume":"21","author":"Bihari","year":"2005","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"524","DOI":"10.3390\/toxins5030524","article-title":"Safety of botulinum toxin A in children and adolescents with cerebral palsy in a pragmatic setting","volume":"5","author":"Papavasiliou","year":"2013","journal-title":"Toxins"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/j.1469-8749.2010.03814.x","article-title":"Adverse events and health status following botulinum toxin type A injections in children with cerebral palsy","volume":"53","author":"Janakan","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s00702-010-0529-x","article-title":"Double-blind, randomised, parallel group pilot study comparing two botulinum toxin type A products for the treatment of blepharospasm","volume":"118","author":"Wabbels","year":"2011","journal-title":"J. Neural Transm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/WNO.0000000000000110","article-title":"A direct comparison of onabotulinumtoxina (Botox) and IncobotulinumtoxinA (Xeomin) in the treatment of benign essential blepharospasm: A split-face technique","volume":"34","author":"Saad","year":"2014","journal-title":"J. Neuro-Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00702-013-1076-z","article-title":"Botulinum toxin therapy of cervical dystonia: Comparing onabotulinumtoxinA (Botox\u00ae) and incobotulinumtoxinA (Xeomin\u00ae)","volume":"121","author":"Dressler","year":"2014","journal-title":"J. Neural Transm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s00276-023-03178-9","article-title":"Guidance in botulinum neurotoxin injection for lower extremity spasticity: Sihler\u2019s staining technique","volume":"45","author":"Hu","year":"2023","journal-title":"Surg. Radiol. Anat."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/bs.irn.2018.07.025","article-title":"Nocebo Responses in Brain Diseases: A Systematic Review of the Current Literature","volume":"139","author":"Zis","year":"2018","journal-title":"Int. Rev. Neurobiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1097\/00001756-200208070-00006","article-title":"Expectation modulates the response to subthalamic nucleus stimulation in Parkinsonian patients","volume":"13","author":"Pollo","year":"2002","journal-title":"NeuroReport"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1007\/s00415-011-6197-4","article-title":"A meta-analytic approach to estimating nocebo effects in neuropathic pain trials","volume":"259","author":"Papadopoulos","year":"2012","journal-title":"J. Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s40259-018-0306-1","article-title":"Non-pharmacological Effects in Switching Medication: The Nocebo Effect in Switching from Originator to Biosimilar Agent","volume":"32","author":"Kristensen","year":"2018","journal-title":"BioDrugs"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.dld.2023.06.022","article-title":"Clinical efficacy and nocebo effect following non-medical biosimilar switch in patients with inflammatory bowel disease: A prospective observational study","volume":"56","author":"Wetwittayakhlang","year":"2024","journal-title":"Dig. Liver Dis."},{"key":"ref_44","first-page":"451","article-title":"The nocebo effect: A reason for patients\u2019 non-adherence to generic substitution?","volume":"65","author":"Weissenfeld","year":"2010","journal-title":"Pharmazie"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1002\/jclp.20131","article-title":"Understanding placebo, nocebo, and iatrogenic treatment effects","volume":"61","author":"Bootzin","year":"2005","journal-title":"J. Clin. Psychol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40945-020-00082-y","article-title":"Context matters: The psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy","volume":"10","author":"Rossettini","year":"2020","journal-title":"Arch. Physiother."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/art.40324","article-title":"Subjective Complaints as the Main Reason for Biosimilar Discontinuation After Open-Label Transition From Reference Infliximab to Biosimilar Infliximab","volume":"70","author":"Tweehuysen","year":"2018","journal-title":"Arthritis Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1213\/ANE.0b013e3181cc5727","article-title":"Nocebo-induced hyperalgesia during local anesthetic injection","volume":"110","author":"Varelmann","year":"2010","journal-title":"Anesth. Analg."},{"key":"ref_49","unstructured":"Nederlandse Vereniging van Ziekenhuisapothekers (NVZA) (2025, January 24). NVZA Toolbox Biosimilars. Published 7 April 2017. Available online: https:\/\/nvza.nl\/wp-content\/uploads\/2017\/04\/NVZA-Toolbox-biosimilars_7-april-2017.pdf."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Herring, S.W., Liu, Z.J., Rafferty, K.L., Baldwin, M.C., Salamati, A., Cunningham, C., Owart, B., and Tamasas, B. (2022). Repeated botulinum treatment of rabbit masseter causes cumulative tissue damage. Arch. Oral Biol., 141.","DOI":"10.1016\/j.archoralbio.2022.105480"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/mus.24576","article-title":"Dramatic changes in muscle contractile and structural properties after 2 botulinum toxin injections","volume":"52","author":"Minamoto","year":"2015","journal-title":"Muscle Nerve"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/3\/103\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:41:09Z","timestamp":1760028069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/3\/103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":51,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["toxins17030103"],"URL":"https:\/\/doi.org\/10.3390\/toxins17030103","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]}}}