In each issue, Modern Aesthetics® magazine asks top cosmetic physicians about the newest devices or products that they are introducing in their practices. Here, Deanne Mraz Robinson, MD, President and Co-Founder of Modern Dermatology in Westport, CT and an Assistant Clinical Professor of Dermatology at Yale New Haven Hospital, gives us a sneak peek of Endo Aesthetics’ Qwo, the first FDA-approved injectable for the treatment of cellulite in adult women, which is slated to launch in Spring 2021.
What is Qwo, and how will you use it in practice?
Deanne Mraz Robinson, MD: Qwo is the first FDA-approved injectable for the treatment of cellulite in adult women. Qwo is an injectable collagenase clostridium histolyticum-aaes (CCH-aaes), which specifically targets Type 1 and Type 3 collagen. I am an investigator for a Phase 3B “real world” study treating buttocks and thighs that is still ongoing.
How does Qwo compare to other cellulite reduction techniques and technologies?
Dr. Robinson: There are FDA-cleared devices that also get to the root cause of cellulite—those fiborous bands under the skin—but Qwo is an injectable and patients are very familiar with aesthetic injectables.There are a lot of injectables for facial aesthetics. There are devices focused on body contouring. But if you think about it, Qwo is really the convergence of both those markets. What is exciting about Qwo is that after it is injected, enzymatic subcision and remodeling (ESR) begins. ESR is believed to initiate as the enzymes work on the fibrous septae to release the cellulite dimple. This enzymatic activity stimulates neocollagenesis. From within, this collagen support network rebuilds itself in the extracellular matrix with thinner, smaller septae. These subdermal changes reduce tension and help thicken the dermis, creating a smoother appearance.
Please share any Qwo treatment pearls/protocols.
Dr. Robinson: Treatment visits for Qwo should be repeated every 21 days for three treatment visits. There is some localized bruising post treatment, so patients should plan their visits accordingly. During clinical trials, Endo took “after” pictures 71 days following the first injection. Patients returned for their final “after” photo 28 days after their third treatment. The long-term durability data from the Phase 2 study were just presented at the American Society for Dermatologic Surgery annual meeting. The conclusion of this publication was that CCH-aaes provided durable improvement in cellulite appearance up to four years after initial dosing and was generally well tolerated.
How has patient satisfaction been with Qwo?
Dr. Robinson: The trials conducted to evaluate Qwo for the treatment of cellulite in adult women remain the largest cellulite studies ever conducted, with 845 participants. At day 71, physicians and patients were asked, independently, to assess the appearance of cellulite in each buttock on a photo-numeric cellulite severity scale (PCSS). Endo studied all Fitzpatrick skin types with nearly 30 percent of those treated with Qwo being Fitzpatrick IV, V and VI. The primary endpoint was the percentage of subjects who had a 2-level improvement on both the patient- and physician-reported scales of cellulite severity. A greater percentage of the 843 women treated during the studies met the primary endpoint. In addition, statistically significant improvements with Qwo versus placebo were observed for eight of eight (in RELEASE 1) and seven of eight (in RELEASE 2) secondary endpoints in target buttocks including the percentage of subjects who experience at least a 1-level or 2-level improvement in patient-reported assessment, the percentage of subjects with a 1-level composite improvement, the percentage of subjects with at least a 1-level or 2-level improvement in the global aesthetic improvement scale (GAIS), percentage of subjects with a 2-level composite improvement in non-target buttocks, percentage of satisfied subjects and change from baseline in a cellulite impact scale (i.e., patients’ self-perception related to their cellulite).
Who makes an ideal Qwo patient?
Dr. Robinson: Qwo is approved for use on the buttocks of adult women. Any woman who is bothered by the dimples, not waves, on their buttocks could be a good candidate for Qwo. Side effects of Qwo included injection site bruising, pain, areas of hardness and itching in the treatment area.
How do you combine it with other treatments for maximum results?
Dr. Robinson: As it is not commercially available and has only been used in the research setting, I have not combined it with other treatments. I can imagine combining it with non-invasive fat reducing modalities and or biostimulatory fillers.
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