Abstract
In contrast to the prevailing arguments presented in the current review, the incidence of neutralising antibody (NAb) formation is not a significant issue for any of the present type A therapeutic botulinum neurotoxin (BoNT) products. Furthermore, clinical non-responsiveness is poorly correlated with the presence of NAbs. The overriding evidence supports the view that the rate of NAb formation is low, does not differ significantly between the different type A BoNT products and that it is not the major factor in clinical response. BoNT products are highly effective and important therapies for the treatment of a variety of neurological and non-neurological conditions.
Highlights
In contrast to the prevailing arguments presented in the current review, the incidence of neutralising antibody (NAb) formation is not a significant issue for any of the present type A therapeutic botulinum neurotoxin (BoNT) products
The manuscript in question seeks to review the role of immunogenicity and the formation of neutralising antibodies (NAbs) in secondary non-responsiveness (SNR) to botulinum neurotoxin (BoNT) treatment, and to relate this to factors such as dosing interval, dose per injection, presence of antigenic protein and the formulation of BoNT product used
The authors note that: ‘studies looking only at clinically responsive patients have found an even higher prevalence of NAbs . . . despite continued clinical response’ [4,5]. Despite this uncertainty about the exact relationship between NAbs and SNR, which the authors discuss at length, they frequently use data based upon measurement of responsiveness to infer conclusions about the relative immunogenicity of different BoNT products and speculate about factors that might potentially have influenced this
Summary
In contrast to the prevailing arguments presented in the current review, the incidence of neutralising antibody (NAb) formation is not a significant issue for any of the present type A therapeutic botulinum neurotoxin (BoNT) products. The manuscript in question seeks to review the role of immunogenicity and the formation of neutralising antibodies (NAbs) in secondary non-responsiveness (SNR) to botulinum neurotoxin (BoNT) treatment, and to relate this to factors such as dosing interval, dose per injection, presence of antigenic protein and the formulation of BoNT product used.
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