For all of you out there, I am at SFO in San Fran stuck because of this M80 airline fiasco and will squeak in for clinic hours in the wee hours on Alaska Airlines through Seattle!  Just finished attending and lecturing at the Rejuvenation of the Aging Face course in SF and wanted to let you guys know what is in the pipeline for upcoming Botox competitors from a lecture given this morning.

As you probably know, Reloxin by Medicis is on the horizon to come out soon.  It is a purified version of Dysport, which has been made by Ipsen originally in England and distributed throughout Europe for the past decade.  Phase III trials have shown it to be as effective as Allergan’s Botox with minimal side effects.  The major concern with Reloxin was whether there is a higher incidence of diffusion of the product.  Sometimes that may be good like on the side of the eyes in the crow’s feet, where perhaps you could inject fewer sites and get the same effect.  Sometimes it could be worse like around the mouth area where you could have adverse effects in speech if it migrates elsewhere.  The area between the eyes for frown lines can lead to eyelid drop (of course, temporarily) with unwanted diffusion but the Phase III trial showed comparable results of ptosis (eyelid drop) as compared with Botox (3.2% in the Botox study and 2.9% in this study).  That’s still pretty high in my opinion.  My rate is a heck of a lot lower than 1%, probably about 1/10th of one percent chance for this temporary problem.  I know that the FDA recently delayed approval for Reloxin so it still may be about 6 months delayed.  I am pretty certain the price will be lower than Botox but the question is by how much.

Another product called Purtox (pronounced Pure-Tox) manufactured by Mentor is probably about 3 or more years away from clinical relevance in the U.S.  Part of the benefit of the product is that it possibly has a quicker onset of action and also fewer antigens that can lead to resistance to the product.  I think this is pretty rare as it is already when it comes to the Botox product, especially since they cleaned up some of these stray proteins in the 90s.  Finally, Xeomin (pronounced Zee-oh-min) is made by German manufacturers Merz and may also have fewer antigens.  All of this is very tentative and really not applicable to the U.S. market for at least several years.  As a point of comparison, Reloxin has been under FDA study for 4 to 5 years before it has made its way to its current final approval process…and it is still not approved yet.