HOW APPROVAL OF A NEW BoNT-A AFFECTS CLINICAL PRACTICE
Novice injectors and experienced injectors using a new product should consider seeing patients back in 2 weeks. Even if an injector has used a new agent in a study, it probably was injected in the standard 5-point way, so they need to identify its nuances outside of that protocol. How much does the product move? What’s the field of action? How does the dosing need to be adjusted?
The introduction of a new BoNT-A provides the opportunity to readdress anatomic considerations. It should make every injector reconsider what they have been doing, and why, and how a new agent can improve on that. Less experienced injectors may think all BoNT-As are pretty much like onabotulinumtoxinA, but they’re not, they’re all different. Each new BoNT needs to be thoroughly evaluated to determine its differences and how they can be used to an advantage, to give better results based on how they affect specific musculature as well as the interplay between muscles.
Patients should not be looking for a provider who advertises the cheapest price by the unit, but rather one who uses all 4 of the available agents and understands how each works. This is an essential part of the recipe for success, because each injector treats patient slightly differently, but only some get great results.
AGENTS ON THE HORIZON
DaxibotulinumtoxinA (Revance Therapeutics, Inc) is currently in clinical development for aesthetic (glabellar lines) as well as therapeutic indications.43-45 Phase 3 clinical trials demonstrate safety and efficacy lasting 6 months or more for moderate to severe glabellar lines.43,44 This agent contains no human serum albumin or other human- or animal-derived components but has a proprietary stabilizing excipient peptide (RTP004) that is cationic and binds to the BoNT-A molecule. DaxibotulinumtoxinA is much different than any of the other available neurotoxins. The panelists related that additional experience with daxibotulinumtoxinA is needed to determine how it will translate to off-label use with regard to dosing, diffusion, longevity, and other effects. It will likely be another agent that reveals the separation between really good injectors and those with less skill. EB-001 (Bonti, Inc.), an investigational BoNT serotype E, has the distinct profile of faster onset of action (about 24 hours) and shorter duration of effect (14-30 days) than commercial BoNT-As.46 It has been tested in phase 2a studies for glabellar lines,46,47 for scar reduction after Mohs surgery,48 and for reducing postsurgical musculoskeletal pain.49,50 The fast onset may benefit patients who desire a rapid treatment for facial rhytides before unexpected social or professional events. The limited duration of effect may be a positive attribute for toxin-naïve patients considering treatment but who are unwilling to make a longer-term commitment,46 but is unlikely to be favored by existing patients.
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- Fagien S, Carruthers JD. A comprehensive review of patient-reported satisfaction with botulinum toxin type A for aesthetic procedures. Plast Reconstr Surg. 2008;122(6):1915-25.
- American Society of Aesthetic Plastic Surgery. 2018 Cosmetic (Aesthetic) Surgery National Data Bank Statistics. Available from: https://www.surgery. org/sites/default/files/ASAPS-Stats2018.pdf. Accessed December 27, 2019.
- Ibrahim O, Keller EC, Arndt KA. Update on botulinum neurotoxin use in aesthetic dermatology. Semin Cutan Med Surg. 2014;33(4):152-6.
- Gart MS, Gutowski KA. Overview of botulinum toxins for aesthetic use. Clin Plast Surg. 2016;43(3):459-71.
- Sundaram H, Signorini M, Liew S, et al. Botulinum toxin type A—evidence-based review, emerging concepts, and consensus recommendations for aesthetic use, including updates on complications. Plast Reconstr Surg. 2016;137(3):518-29.
- Fardouly J, Vartanian LR. Social media and body image concerns: current research and future directions. Curr Opin Psychol. 2016;9:1-5.
- Perrin A, Kumar M. About three-in-ten U.S. adults say they are ‘almost constantly’ online. Pew Research Center July 25, 2019. Available at: http://www. pewresearch.org/fact-tank/2019/07/25/americans-going-online-almost-constantly/. Accessed December 27, 2019.
- Sherber NS. The millennial mindset. J Drugs Dermatol. 2018;17(12):1340-2.
- US Census Bureau. Millennials Outnumber Baby Boomers and Are Far More Diverse, Census Bureau Reports. June 25, 2015. Available at: https://www. census.gov/newsroom/press-releases/2015/cb15-113.html. Accessed December 27, 2019.
- Hilton L. Aesthetic medicine: marketing by generation. Dermatology Times. January 7, 2019. Available at: https://www.dermatologytimes.com/practice-management/aesthetic-medicine-marketing-generation. Accessed December 27, 2019.