Background on Botox:

Botox® is a multipurpose therapeutic agent that has been used to treat everything from chronic migraines and urinary incontinence to hyperhidrosis and facial spasms. In the context of cosmetics and aesthetics, Botox® is used to treat frown lines, crow’s feet, gummy smile, and facial wrinkles among other things. Its versatility, reliability, and safety make Botox® treatment the most common cosmetic intervention used today with over 7 million procedures being performed every year. Before we discuss the advent of its emerging competitor Jeuveua®, let us quickly review the origin of Botox® and its mechanism of action.

Botox® is derived from the botulinum toxin, a molecule produced by the bacteria Clostridium botulinum. Botulinum toxin acts on nerves to prevent the release of acetylcholine, a neurotransmitter that binds to receptors on muscles to elicit contractions. By blocking the function of acetylcholine, this neurotoxin causes muscle paralysis. Clinically, we harness this paralytic activity to prevent unwanted muscle contractions responsible for wrinkles. By targeting specific skin regions—for example, in the forehead or in-between the eyes—Botox® and similar agents such as Jeuveua® reduce unwanted strain, allowing the skin to appear supple, relaxed, and rejuvenated.

The New Disruptor: Implications on the Market and Future Patients

Because of high demand, it should come to no surprise that the neurotoxin market is highly competitive. Pharmaceutical companies are constantly exploring new molecules to compete against Allergan’s Botox®, the leading cosmetic agent of its type. Most recently, the US Food and Drug Administration (FDA) approved Jeuveua® (prabotulinmtoxinA), a novel analog of botulinum toxin produced by the California-based company Evolus for the treatment of facial wrinkles. With positive Phase III trials showing excellent safety and clinical outcomes, Jeuveua® is predicted to become a formidable competitor to not only Allergan’s Botox®, but also Ipsen Biopharm’s Dysport® and Merz Pharma’s Xeomin®.

So, what does this mean for the consumer? Evolus plans to make Jeuveua® available in the United States by Spring of 2019. It is expected that 50% of Jeuveua® will be prescribed for aesthetic reasons and the other 50% for off-label therapeutics such as facial spasms and migraines. This marketing plan will allow Evolus to be provide flexible and competitive prices. The company also plans to market Jeuveua® to a growing audience of millennials through social media outlets and a digital platform. Finally, Evolus hopes to present Jeuveua® as a novel alternative to Botox® that physicians can adopt with minimal additional training. If successful, Evolus and Jeuveua® are expected to disrupt the US aesthetic neurotoxin market, a market that has not had a new entrant for nearly 10 years.
With the number of patients seeking aesthetic treatment increasing—especially among 20 to 30 year-olds—the emergence of Jeuveua® will give patients and physicians additional therapeutic options as well as increase competition amongst manufacturers. This will encourage innovation that will ultimately work to benefit the consumer. Time will tell whether Jeuveua® will replace Botox®, Dysport®, or Xeomin®. For now, patients and physicians must work together to evaluate differences between products to determine what best works for them and their needs.


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