Toxins, Toxins, and More Toxins

With 30-plus fillers available in the US already and even more coming down the pike, cosmetic doctors already have a lot to choose from for plumping lips, cheeks, and nasolabial folds. But the currently available neuromodulators—Botox Cosmetic (Allergan), Dysport (Galderma), and Xeomin (Merz)—all behave in a similar fashion, leaving much room for innovation and differentiation in this category.

And now it's toxin time. The neuromodulator pipeline is fairly robust.

So “hot” is this category that it garnered an entire Hot Topic's presentation at the American Society for Aesthetic Plastic Surgery's 2018 annual meeting in New York City.

Evolus, Revance, and Bonti all have a stake in the game, and the race is on.

The FDA did not approve DWP-450, Evolus Inc.'s rival product to Allergan Botox, due to chemistry and manufacturing issues, which was something of a blow. As a result, the company pushed its estimate for the launch of the drug to the spring of next year.

Revance was once working on a topical Botox alternative, but the company seems to have shifted their focus toward a longer-acting injection of daxibotulinumtoxinA, which is not yet approved by the FDA. The company and Mylan N.V. are also partnering to develop a biosimilar to Botox (onabotulinumtoxinA). And Bonti's lead product candidate, EB-001, a botulinum toxin type E, is characterized by a fast onset of action (about 24 hours) and a short duration of effect (about four weeks).

Stay tuned.


Cottage Cheese Butts and Thighs

Before you get too excited, we haven't discovered a cure for cellulite, a vexing condition that affects more than 85 percent of women over the age of 21, according to the American Society for Dermatologic Surgery (ASDS). That said, we do have more techniques and technologies available than ever before and even more coming. Owing largely to such improvements in technology, cellulite treatments increased nearly 20 percent during the last year, according to the American Society of Plastic Surgeons (ASPS). There's a lot of excitement and enthusiasm around Endo Pharmaceutical's Xiaflex (collagenase clostridium histolyticum), which is already approved to treat Dupuytren's contracture and Peyronie's disease. Xiaflex may work by breaking the bonds of the collagen structure. The company just initiated two Phase 3 clinical trials looking at the drug's effectiveness for treating cellulite. Cellfina and Cellulaze, two minimally invasive procedures to treat areas of cellulite, have shown good results that are lasting thus far up to five years. Other non-invasive treatments include external radiofrequency treatments, shockwave therapy, suction roller, and LED therapy, and more in the pipeline. I am looking forward to what the future holds and think we may be seeing less and less cellulite as a result of new and coming treatments. It's an exciting time. n