TrenibotulinumtoxinE: Pharmacology, clinical evidence, and emerging role in aesthetic medicine

Botulinum neurotoxin type A (BoNT/A) products are among the most popular aesthetic treatments worldwide, but their relatively prolonged duration may be a barrier for patients who are concerned about unnatural appearance, adverse effects, or being committed to an unwanted result. TrenibotulinumtoxinE (trenibotE), a botulinum neurotoxin type E formulation, has a distinctly rapid onset and shorter duration of action, providing a pharmacologic profile that differs from currently available BoNT/A products and may better meet the needs of certain patients seeking greater treatment flexibility. This narrative review summarizes the pharmacology, clinical development, efficacy, safety, and potential aesthetic role of trenibotE based on preclinical and clinical studies. Preclinical studies demonstrate a more rapid onset and shorter duration of neuromuscular effect with trenibotE than with BoNT/A, likely reflecting differences in intracellular persistence, receptor interactions, and SNAP-25 cleavage. In clinical studies of moderate-to-severe glabellar lines (GL), improvement was evident within 8–24 hours, with peak efficacy around Day 7 and return toward baseline by approximately Day 21. Phase 3 trials reported that approximately 60%–66% of trenibotE-treated participants achieved a ≥2-grade improvement to none or mild GL severity at Day 7. Patient-reported outcomes showed high satisfaction, including satisfaction with natural-looking results and improvement in the psychological impact of GL. TrenibotE was generally well tolerated, with low rates of treatment-related adverse events and no treatment-emergent neutralizing antibodies reported. TrenibotE represents a rapid-onset, short-acting neuromodulator with a clinical profile that may complement existing BoNT/A treatments. Its shorter duration may be particularly appealing to toxin-naive or treatment-hesitant patients and may provide greater flexibility for individualized aesthetic treatment. Further studies are needed to characterize repeated use, long-term safety and immunogenicity, diffusion, dose optimization, treatment of non-glabellar areas, and direct comparisons with BoNT/A.