Authors' objectives: What are the comparative clinical efficacy and safety of botulinum neurotoxin type A (BoNT-A) products in pediatric and adult patients with upper limb spasticity, lower limb spasticity, or cervical dystonia (CD)? What are the clinical effectiveness and safety of switching between BoNT-A products in pediatric and adult patients with upper limb spasticity, lower limb spasticity, or CD? What are the evidence-based guidelines regarding the use and administration (including switching guidance) of BoNT-A products for pediatric and adult patients with upper limb spasticity, lower limb spasticity, or CD?

Authors' results and conclusions: What Is the Issue? BoNT-A has been used to treat excessive muscle contractility in patients with movement disorders, including CD and spastic conditions, as well as for cosmetic purposes. Health Canada has approved 3 BoNT-A products for various therapeutic uses: onaBoNT-A, aboBoNT-A, and incoBoNT-A. Decision-makers are interested in understanding the comparative clinical efficacy and safety of these products and the clinical effectiveness and safety of switching from 1 product to another in pediatric and adult patients with limb spasticity or CD. They are also interested in recommendations from evidence-based guidelines on the use of BoNT?A products for these indications in children and adults. What Did We Do? We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2013. What Did We Find? Clinical evidence suggests that onaBoNT-A and aboBoNT-A are comparatively effective and safe for the treatment of limb spasticity in children. OnaBoNT-A, aboBoNT-A, and incoBoNT-A are comparable in terms of efficacy and safety for the treatment of CD in adults. Switching from onaBoNT-A or aboBoNT-A due to treatment failure to incoBoNT-A in adult patients with CD is possible. Evidence-based guidelines recommend onaBoNT-A, aboBoNT-A, and incoBoNT-A as treatment options for upper limb spasticity, lower limb spasticity, and CD in adults. What Does This Mean? OnaBoNT-A, aboBoNT-A, and incoBoNT-A can be used to treat upper and lower limb spasticity in children and adults and CD in adults. Switching between products is possible, provided that the recommended conversion ratios are applied.

Project Status: Completed

URL for project: https://www.cda-amc.ca/botulinum-toxin-products-comparison-upper-limb-spasticity-lower-limb-spasticity-and-cervical

Year Published: 2026

URL for published report: https://www.cda-amc.ca/botulinum-toxin-products-comparison-upper-limb-spasticity-lower-limb-spasticity-and-cervical

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Canada

Organisation Name: Canada’s Drug Agency (CDA-AMC)

Contact Address: 865 Carling Ave., Suite 600 Ottawa, ON Canada K1S 5S8

Contact Name: Shannon Nordstrom

Contact Email: shannon.nordstrom@cda-amc.ca

Copyright: 2025 Canadian Agency for Drugs and Technologies in Health