Deoxycholic Acid (ATX-101) for Fat Reduction

November 2021 | Volume 20 | Issue 11 | Original Article | 1169 | Copyright © November 2021

Published online October 29, 2021

Jyoti Gupta MDa, Martin Kassir MDb, George Kroumpouzos MDc, Andreas Katsambas MDd, Hassan Galadari MDe, Torello Lotti MDf, Uwe Wollina MDg, Stephan Grabbe MDh, Mohamad Goldlust MDi

aDermaClinix-The Complete Skin and Hair Solution Center, Delhi, India
bWorldwide laser institute, Dallas, TX
cDepartment of Dermatology, Alpert Medical School of Brown University, Providence, RI
dDepartment of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, MA; University of Athens, Athens, Greece
eCollege of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
fUniversity of Studies Guglielmo Marconi, Rome, Italy
gDepartment of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Germany
hDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
iDepartment of Dermatology, University Medical Center Mainz, Mainz, Germany

Excess, unwanted fat in submental and other body areas has been a focus of new modalities in aesthetics. Invasive and, more recently, non-invasive modalities for removal of unwanted fat have been on an increase. ATX-101 (deoxycholic acid injection) is the only injectable drug approved in the United States and Canada for reduction of moderate or severe submental fat in adults, with ongoing trials testing its efficacy in body contouring and lipomas. It has proven efficacy in submental fat reduction with a good safety profile. This article reviews the pharmacology, mechanism of action, clinical effects and adverse effects of ATX-101. It emphasizes on careful patient selection and advises on appropriate volume administration, number of treatments, and injection technique. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till December 2019 and reference lists of respective articles. Only articles published in English language were included.

J Drugs Dermatol. 2021;20(11):1169-1173. doi:10.36849/JDD.3936


Deoxycholic acid injection (DCA) is a pure synthetic formulation of deoxycholate sodium which has been patented as ATX-101.1,2 It is one of the first injection of deoxycholate that has been FDA approved for submental fat (SMF) reduction. It is branded/marketed as Kybella® (USA), Belkyra (Canada) and ATX-101 (Allergan company, Ireland).3,4 ATX-101 is a synthetic replicate of the in vivo bile acids (deoxycholic acid) [Figure 1], and functions as fat emulsifier.2 Its approval for SMF reduction by the FDA and Health Canada warrants its action on fat reduction/dissolution at other sites in the future.5

ATX-101 is a synthetic replicate of endogenous DCA. The experiments on rat,3 helped us to know that the tissue distribution of ATX-101 is similar to endogenous DCA. Even after subcutaneous injection, its secretion is mediated by liver and small bowel and is recycled by the enterohepatic circulation.7,9

Understanding of the pharmacokinetics, pharmacodynamics mechanism and safety profiles of ATX-101 have opened up future prospects of its uses. Walker et al8 showed that the pharmacological profile for ATX-101 is equivalent for each treatment setting irrespective of the number of injections and the volume of administered drug. Walker et al9 further suggested that the addition of benzyl alcohol as a preservative has no significant effects on the overall pharmacokinetic profile of ATX-101.