1. Introduction: Neuronox and NABOTA Beyond the Brand Comparison

Neuronox and NABOTA are botulinum toxin type A (BoNT-A) products developed by two South Korean pharmaceutical companies: Medytox Inc. and Daewoong Pharmaceutical, respectively. Both have been investigated in clinical development programs, including randomized trials involving onabotulinumtoxinA as an active comparator. ［1–5］

A comprehensive comparison involves more than product names. It requires examining the clinical evidence supporting each preparation, the scope of its research program, product-specific information, and relevant manufacturer history.

Neuronox has published randomized comparative evidence in glabellar lines and several therapeutic indications. Its Phase III glabellar-line study reported a Week-4 responder rate of 93.7%, compared with 94.5% for onabotulinumtoxinA, meeting the prespecified non-inferiority criterion. ［2］

The DWP450/prabotulinumtoxinA development program associated with NABOTA also includes randomized glabellar-line studies against onabotulinumtoxinA and placebo. ［4,5］

Beyond clinical research, the manufacturers have been involved in a significant legal dispute concerning the origin of a Clostridium botulinum strain and manufacturing-related trade secrets. In February 2023, a South Korean court issued a first-instance judgment in favor of Medytox. Subsequent proceedings continued into 2026. ［6–9］

These subjects provide distinct perspectives on the two products and their manufacturers.

2. Manufacturer and Product Identity

Neuronox is manufactured by Medytox Inc., Republic of Korea. Its Thai product information identifies it as a botulinum toxin type A product. ［1］

NABOTA is a botulinum toxin type A product of Daewoong Pharmaceutical. Published clinical research associated with its development program uses the terminology DWP450 and prabotulinumtoxinA. ［3–5］

Table 1. Product Overview

Parameter

Neuronox

NABOTA

Manufacturer

Medytox Inc.

Daewoong Pharmaceutical

Country of manufacturer

Republic of Korea

Republic of Korea

Product class

Botulinum toxin type A

Botulinum toxin type A

Relevant clinical research terminology

Neuronox; Meditoxin in certain publications

DWP450; prabotulinumtoxinA

Clinical evidence discussed here

Randomized active-comparator trials in aesthetic and therapeutic indications

Randomized trials in glabellar lines

Approved indications and presentations

Subject to current local product information

Subject to current local product information

The product name, preparation, indication, and regulatory jurisdiction should be verified when interpreting clinical publications.

3. Neuronox: Product-Specific Clinical Evidence

An important feature of the Neuronox evidence base is the availability of randomized comparative studies across both aesthetic and selected therapeutic indications.

Its published clinical program includes research in glabellar lines, essential blepharospasm, spastic equinus in children with cerebral palsy, and post-stroke upper-limb spasticity. ［2,10–12］

These studies allow Neuronox to be discussed using findings generated from the investigated product rather than relying exclusively on evidence from the broader BoNT-A class.

3.1 Phase III Glabellar-Line Study

Lee WS and colleagues conducted a randomized, double-blind, active-controlled, multicenter Phase III study comparing a Neuronox preparation with onabotulinumtoxinA in 314 participants with glabellar lines. ［2］

The study evaluated efficacy and safety, with the reported Week-4 response rates shown below.

Table 2. Neuronox Phase III Glabellar-Line Results

Study Parameter

Neuronox Preparation

OnabotulinumtoxinA

Week-4 responder rate

93.7%

94.5%

Comparative finding

Prespecified non-inferiority criterion met

Active comparator

The total study population was 314 participants across both treatment groups.

The study met its prespecified non-inferiority criterion. This is a product-specific clinical finding relevant to the investigated glabellar-line treatment. ［2］

3.2 Clinical Evidence in Therapeutic Indications

Neuronox also has published randomized comparative studies in therapeutic settings.

Table 3. Additional Neuronox Clinical Research

Clinical Indication

Published Study

Evidence Discussed

Essential blepharospasm

Yoon JS et al., 2009

Randomized comparison of Meditoxin with Botox

Spastic equinus in children with cerebral palsy

Kim K et al., 2011

Randomized, double-blind comparison of Neuronox with BOTOX

Post-stroke upper-limb spasticity

Nam HS et al., 2015

Multicenter, randomized, double-blind Phase III comparison

The blepharospasm and cerebral-palsy studies reported that their prespecified primary non-inferiority criteria were met. The post-stroke study evaluated changes in the Modified Ashworth Scale within a non-inferiority framework. ［10–12］

These publications demonstrate the breadth of the investigated Neuronox clinical program across distinct patient populations and treatment objectives.

4. NABOTA: Evidence From the DWP450/PrabotulinumtoxinA Development Program

Daewoong's DWP450/prabotulinumtoxinA program includes randomized clinical trials evaluating treatment of moderate-to-severe glabellar lines.

The identified publications include comparisons against onabotulinumtoxinA and a Phase III study incorporating placebo. ［4,5］

4.1 DWP450 Active-Controlled Study

Won CH and colleagues published a multicenter, randomized, double-blind, active-controlled study comparing DWP450 with onabotulinumtoxinA in glabellar lines. ［4］

The study provides product-specific comparative evidence for the investigated DWP450 preparation.

4.2 PrabotulinumtoxinA Phase III Study

Rzany BJ and colleagues published a multicenter, randomized, double-blind, placebo-controlled, single-dose Phase III study evaluating prabotulinumtoxinA and onabotulinumtoxinA in moderate-to-severe glabellar lines. ［5］

The trial used a prespecified non-inferiority framework for the active comparison.

Together, these studies document the clinical development of the investigated preparation in glabellar-line treatment.

5. Neuronox vs NABOTA: Clinical Evidence at a Glance

The identified Neuronox and DWP450/prabotulinumtoxinA studies were conducted separately. Their findings can be presented side by side, while retaining the original design and endpoint of each publication.

Table 4. Overview of the Identified Clinical Programs

Evidence Parameter

Neuronox

DWP450/PrabotulinumtoxinA Program

Published glabellar-line research

Phase III randomized active-comparator study

Randomized active-comparator and Phase III studies

Active comparator

OnabotulinumtoxinA

OnabotulinumtoxinA

Additional therapeutic research identified in this review

Blepharospasm, cerebral-palsy spastic equinus, post-stroke upper-limb spasticity

Not evaluated in the selected publications reviewed here

Product-specific clinical evidence

Available

Available

Direct Neuronox-versus-NABOTA randomized comparison

Not identified in the reviewed source set

Not identified in the reviewed source set

The distinction in the therapeutic-research row reflects the scope of the publications selected for this article; it is not a claim that no other research exists.

6. Medytox vs Daewoong: The Botulinum Toxin Strain and Trade-Secret Dispute

A notable part of the manufacturers' history is the legal dispute concerning the origin of a Clostridium botulinum strain and manufacturing-related trade secrets.

Medytox alleged that Daewoong had improperly obtained and used its bacterial strain and confidential manufacturing information. Daewoong disputed those allegations and maintained that it had independently obtained its strain. ［6–9］

The dispute led to proceedings in South Korea and the United States.

6.1 U.S. International Trade Commission Proceedings

Medytox and Allergan initiated proceedings before the United States International Trade Commission (ITC) concerning alleged misappropriation of trade secrets related to botulinum toxin.

In December 2020, the ITC issued a determination finding a violation of Section 337 and imposed a 21-month exclusion order affecting the relevant Daewoong-associated product, Jeuveau. ［6,7］

The U.S. proceedings subsequently changed following settlement arrangements in 2021. The exclusion order was rescinded, and the ITC determination was vacated.

Accordingly, the 2020 exclusion order should be understood in its historical context rather than described as a currently operative import restriction. ［6,7］

6.2 South Korean Court Judgment in February 2023

On February 10, 2023, the Seoul Central District Court issued a first-instance judgment in the civil dispute brought by Medytox against Daewoong.

The court ruled in favor of Medytox and ordered measures concerning the manufacture and sale of the disputed product, along with damages of approximately KRW 40 billion. ［8,9］

The judgment concerned the alleged misuse of Medytox's bacterial strain and manufacturing-related trade secrets.

Daewoong challenged the judgment, and the dispute proceeded through the appellate process.

6.3 Developments Reported in September 2026

Reports published in September 2026 indicated that the South Korean litigation remained active at the appellate stage.

Medytox increased its damages claim from KRW 50 billion to KRW 500 billion, citing sales-related information and its assessment of the alleged economic harm. ［13,14］

The increased figure represents the amount sought by Medytox in the ongoing proceedings, rather than an additional damages award already ordered by the court.

Table 5. Key Events in the Medytox–Daewoong Dispute

Date

Event

Reported Outcome or Status

2017

Medytox initiated civil litigation in South Korea

Dispute concerning the bacterial strain and trade secrets

December 2020

U.S. ITC determination

Section 337 violation finding and 21-month exclusion order

2021

Settlement-related developments in the United States

Exclusion order rescinded and ITC determination vacated

February 2023

Seoul Central District Court first-instance judgment

Judgment in favor of Medytox, including approximately KRW 40 billion in damages

September 2026

Further developments in the South Korean proceedings

Medytox increased its damages claim to KRW 500 billion; appellate proceedings remained ongoing

The South Korean first-instance judgment and the U.S. ITC proceedings are separate legal matters. Their procedural histories and outcomes should be identified independently.

7. Why the Legal Dispute Matters in a Manufacturer Comparison

The Medytox–Daewoong dispute concerns issues extending beyond ordinary commercial competition, including the origin of a bacterial strain, confidential manufacturing information, and intellectual-property rights.

For readers evaluating the manufacturers, the dispute provides relevant historical context about the development and production of botulinum toxin products.

The February 2023 South Korean judgment is particularly significant to this history because the first-instance court ruled in favor of Medytox on the disputed matters. ［8,9］

The subsequent appeal and later damages claim are also relevant to understanding the procedural status of the dispute as of September 2026.

Product-specific clinical evidence and legal developments should be documented through their respective sources: clinical publications for treatment outcomes, and court decisions or reliable legal reporting for litigation.

8. Product-Specific Potency Units and Dosing

Botulinum toxin potency units are product-specific. A numerical dose used in a Neuronox study should not automatically be treated as equivalent to the same numerical dose reported in a separate NABOTA-related trial.

Clinical dosing depends on the product, approved indication, target muscle, administration protocol, and patient characteristics.

Table 6. Interpreting Dosing Information

Information

Appropriate Interpretation

Identical numerical doses in separate studies

Does not independently establish dose equivalence

Both products belong to the BoNT-A class

Does not establish a universal unit-conversion ratio

Product-specific clinical trials

Support conclusions within their respective study protocols

Locally approved product information

Governs authorized dosing and administration in the relevant jurisdiction

Current locally approved product information should be consulted before clinical use.

9. Frequently Asked Questions

Are Neuronox and NABOTA manufactured by the same company?

No. Neuronox is manufactured by Medytox Inc., while NABOTA is a product of Daewoong Pharmaceutical. Both companies are based in South Korea. ［1,3］

Does Neuronox have published randomized clinical trials?

Yes. Its published clinical program includes randomized comparative research in glabellar lines and selected therapeutic indications. ［2,10–12］

What did the Neuronox Phase III glabellar-line study report?

The study included 314 participants and reported Week-4 responder rates of 93.7% for the Neuronox preparation and 94.5% for onabotulinumtoxinA. Its prespecified non-inferiority criterion was met. ［2］

Has NABOTA been investigated in randomized glabellar-line trials?

Yes. Published studies involving the DWP450/prabotulinumtoxinA program include randomized comparisons with onabotulinumtoxinA and placebo. ［4,5］

Did Medytox win a lawsuit against Daewoong?

In February 2023, the Seoul Central District Court issued a first-instance judgment in favor of Medytox in the dispute concerning the bacterial strain and manufacturing-related trade secrets. Daewoong challenged the judgment, and appellate proceedings continued into 2026. ［8,9,13,14］

What happened in the U.S. ITC proceedings?

The ITC issued a determination and exclusion order in December 2020. Subsequent settlement-related developments in 2021 resulted in the exclusion order being rescinded and the determination being vacated. ［6,7］

Can Neuronox and NABOTA units be converted using a universal 1:1 ratio?

A universal conversion should not be assumed. Potency units and dosing information are product-specific.

10. Conclusion

Neuronox and NABOTA are distinct South Korean botulinum toxin type A products with separate manufacturers and clinical development programs.

Neuronox has published product-specific randomized evidence in both aesthetic and selected therapeutic indications. Its Phase III glabellar-line study reported a 93.7% Week-4 responder rate and met the prespecified non-inferiority criterion against onabotulinumtoxinA. ［2,10–12］

The DWP450/prabotulinumtoxinA program associated with NABOTA has also been evaluated in randomized glabellar-line trials. ［4,5］

An additional part of the manufacturers' history is the Medytox–Daewoong legal dispute. In February 2023, a South Korean court issued a first-instance judgment in favor of Medytox concerning the bacterial strain and manufacturing-related trade secrets. The dispute remained subject to further proceedings in 2026. ［8,9,13,14］

Taken together, these materials provide a basis for understanding Neuronox's clinical research program, the evidence associated with NABOTA, and the documented legal history of their manufacturers.

References

［1］ NEURONOX (Botulinum Toxin Type A). Thai product information. Revised April 3, 2023. Manufacturer: Medytox Inc., Republic of Korea.

［2］ Lee WS, et al. Efficacy and safety of a new botulinum toxin type A for glabellar lines: randomized, double-blind, active-controlled, multicenter phase III study. Dermatol Surg. 2013;39:171–178. doi:10.1111/dsu.12072.

［3］ Daewoong Pharmaceutical. NABOTA product information webpage. Product presentations and selected approved indications by market. Accessed September 2026.

［4］ Won CH, et al. Comparative trial of DWP450 versus onabotulinumtoxinA in glabellar lines: multicenter, randomized, double-blind, active-controlled study. Int J Dermatol. 2015;54:227–234. doi:10.1111/ijd.12627.

［5］ Rzany BJ, et al. A multicenter, randomized, double-blind, placebo-controlled, single-dose, phase III, non-inferiority study comparing prabotulinumtoxinA and onabotulinumtoxinA for moderate-to-severe glabellar lines. Aesthet Surg J. 2020;40:413–429. doi:10.1093/asj/sjz110.

［6］ U.S. International Trade Commission. Investigation No. 337-TA-1145. Final determination and remedial orders, December 2020; subsequent procedural developments.

［7］ U.S. International Trade Commission. Investigation No. 337-TA-1145. Settlement-related rescission and vacatur proceedings, 2021.

［8］ Seoul Central District Court. Medytox Inc. v. Daewoong Pharmaceutical. First-instance civil judgment, February 10, 2023.

［9］ Reports on the February 2023 Seoul Central District Court judgment concerning the Medytox–Daewoong bacterial-strain and trade-secret dispute.

［10］ Yoon JS, Kim JC, Lee SY. Meditoxin versus Botox in essential blepharospasm. Korean J Ophthalmol. 2009;23:137–141. doi:10.3341/kjo.2009.23.3.137.

［11］ Kim K, et al. Neuronox versus BOTOX for spastic equinus gait in children with cerebral palsy. Dev Med Child Neurol. 2011;53:239–244. doi:10.1111/j.1469-8749.2010.03830.x.

［12］ Nam HS, et al. Neuronox versus BOTOX for post-stroke upper-limb spasticity. PLoS ONE. 2015;10:e0128633. doi:10.1371/journal.pone.0128633.

［13］ September 2026 reporting on Medytox's increased damages claim in the South Korean litigation against Daewoong.

［14］ September 2026 reporting on the appellate status of the Medytox–Daewoong dispute.

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