Daxxify

Finally, there is a new neurotoxin coming to market that REALLY is different from the other toxins out there (Botox®, Dysport®, Xeomin® and Jeuveau®) and St. Louis Skin Solutions has been chosen to be one of the first practices to carry it! 

We are honored to help launch what I think will be a game-changer in the field of aesthetic medicine.  Daxxify®, or Daxi for short, has the same active ingredient as all the others, yet it is formulated to last longer.  On average, twice as long as the others!!!!  Now, of course, everyone’s physiology is a bit different, and bodies handle and process medications at different rates.  When we say “average” that means some people got an even longer duration of action and some got a shorter duration—but still longer than the others with the other brands of neurotoxin.  Imagine instead of having to get injections every 3 months for best effect, 2xs a year should do it.  Less sharp needles coming at me—YES PLEASE!! 

I have a feeling that Daxi is going to shake up the industry much like when the first hyaluronic acid filler was introduced over 20 years ago.  Before we had HA’s like Restylane® and Juvéderm®, injectable collagen was the only thing available for the injectable treatment of lines, wrinkles, and lips.  While collagen is a beautiful filler and integrates into tissue smoothly and naturally, it would only last 6 to 12 weeks.  Say you are a bride and want voluptuous lips for your shower, wedding, and honeymoon then collagen is a great option. Understand that by the time the honeymoon was over though, your lips would be too.   

Then hyaluronic acid fillers came along.  No one quite believed that they would last a whole 6 months or more.  You could really keep your voluptuous lips past the honeymoon?!  No Way!  But it was true.  Now we have all sorts of HAs of different strengths and flexibilities and no one uses collagen anymore.  Collagen injections died quickly and any injector worth their salt learned the nuances of working with the various types of HAs.  I think the same will be true with neurotoxins.  We will look back and say, “I really went in every 3 months, that was ridiculous!”  Who knows, maybe, like the HAs, there will be a variety, with some lasting 18 months or more.  It is fun to speculate, but I digress. I want to talk about Daxxify®. 

To understand how Daxi is different it is helpful to get an understanding of how neurotoxins work in general.  When injected, the toxin basically stops communication between the nerve ending and the muscle. So, when your brain says I need to scratch my nose, an electrical impulse is generated in the brain and runs down the spinal cord to the arm to lift your hand.  The impulse jumps form to neuron to neuron as it travels and at the last neuron, the impulse jumps to the bicep muscle, causing it to contract and lift your arm to your face. When injected into the muscle, the neurotoxin adheres to that last neuron and the impulse is stopped dead in its tracks.  The longer that neurotoxin stays around and clogs up the connection between the nerve and muscle, the longer it works to keep the muscle still and the skin smooth.  With most of us, our bodies can get rid of the toxin in 2 to 4 months, necessitating repeated injections throughout the year to maintain results.  (This leads to other problems, like a “desensitizing” of the body to the neurotoxin, possibly making it less effective over time.  Some researchers think this is due to repeated exposure helping the immune system to build antibodies, but that is a whole other can of worms we can open and explore later.)

So, the burning question for the last 20 years or so has been how do we get the neurotoxin to stick around longer?  This is where Daxi’s story gets interesting.

Several years ago, a small U.S. company, Revance, developed a proprietary platform that allowed transcutaneous (through the skin) absorption of large medicinal compounds (1).  This was initially developed to try and deliver insulin topically, so diabetics would not have to be sticking themselves constantly to deliver their life-saving medication.  That didn’t work out too terribly well, but research is ongoing.  This ‘proprietary platform’ developed by Revance consisted of something called CPPs or cell permeating proteins.  CPPs have all sorts of applications in medicine from helping diagnose diseases to delivering medications or other therapies (2).  Revance was interested in using CPPs to get neurotoxin through the skin for both medical and aesthetic purposes.  They tried, but it just didn’t work (3).  Research is continuing, however, and maybe in the future, there will be an efficacious topical neurotoxin.

Revance realized that their CPP technology had other applications.  When combined with the naked 150KD neurotoxin molecule, it seemed to help the neurotoxin act longer, therefore giving longer results.  The addition of CPP, a tiny 5KD protein, didn’t cause any additional problems or side effects either (4).  Could this be true?  How did the CPP do that?

They found that the positively charged CPP helped the toxin stick to the negatively charged nerve ending, allowing more of the toxin to do its job for a longer period of time.  I think of it like attaching some Velcro to the neurotoxin and allowing it to attach to the naturally occurring “Velcro” on the nerve ending.  This enhanced binding may also reduce diffusion from the injection site (5) with a 100% to 126% increase in the duration of effect compared to Botox® (5).  The CPP also helps the neurotoxin from sticking to itself and clumping up, as well as helping to keep it from sticking to the inner walls of the vial and syringe, so more active, viable neurotoxin gets where it needs to go. 

Revance tested thousands of CPPs, and it took several years to find the exact right one.  Personally, I’m not patient enough for all that, but I’m so glad Revance was because they’ve got something good on their hands!  The best news?  Even though it is double the duration, it is NOT double the cost!  Plus, since St. Louis Skin Solutions is one of the first practices to use it, we can offer it at an even better introductory price for the next few months.

Ok, so the bad news.  You will need a few more units of Daxxify® to get a better result as well as the longevity.  This is because the unit of measurement for a neurotoxin unit is not standardized so a unit of Botox® is not equivalent to a unit of Xeomin® or a unit of Dysport®.  The companies each have their own parameters for establishing what dose of the neurotoxin is in each unit.  So, for every unit of Botox®, you need (IMO) about 3 of Dysport®, 1.2 or so of Xeomin®, and 1.5 to 2 of Daxxify®, approximately. 

The actual number of units used in your treatment may be higher, and the initial cost may be higher than you are used to. However, the “per day” cost of Daxxify® verses all the others is going to be MUCH lower since it lasts so much longer.  Plus, you get the convenience of twice-yearly dosing.  What’s not to love?

So, if you want to be one of the first in the world (that’s right, as a U.S. company Revance is releasing it to the U.S. first!) call us! Don’t worry, it has been studied on over 2800 patients, with 4,444 treatments in the clinical trials (6,7).  In the non-US trial locations, these patients will have to wait until Daxxify® is available in their country to get it again. (I’ve heard that some of the Canadian patients are none too happy about this).  If you’ve ever wished your tox treatment lasted longer, now is the time to try Daxxify®!  After the introductory period, the price will go up, but if you get in soon we will carry that intro price for your second treatment so you will get a whole year at a great price.  Call or email for more info!

References:

1. Jancin B. Topical Botulinum Toxin Will Turn Market Upside Down. Derm.Times April 25, 2012. https://www.mdedge.com/dermatology/article/52663/aesthetic-dermatology/topical-botulinum-toxin-will-turn-market-upside-down.  Accessed 12/22.
2. Xie J, Bi Y, Zhang H, Dong S, Teng L, Lee R et al. Cell-Penetrating Peptides in Diagnosis and Treatment of Human Diseases: From Preclinical Research to Clinical Application. Front Pharmacol. May 2020. https://doi.org/10.3389/fphar.2020.00697. Accessed 12/22.
3. Chacon, A. Topical Botulinum Toxin: An Update. Aesthetic Authority Derm. Times. 10/2020. https://www.aestheticauthority.com/view/topical-botulinum-toxin-an-update accessed 12/22.
4. Green J, Mariwalla K, Coleman K, Ablon g, Weinkle S, Gallagher C et al. A Large, Open -Label, Phase 3 Safety Study of DaxibotulinumtoxinA for Injection in Glabella Lines: A Focus on safety From SAKURA 3 Study. Derm Surg. (2021) 47(1):42-46.
5. Solish N, Carruthers J, Kaufman J, Rubio R, Gross T, Gallagher C. Overview of Daxibotulinumtoxin A for Injections: A Novel Formulation. Drugs (2021) 81:2091-2101.
6. Carruthers J, Fagien S, Joseph, Humphrey S, Biesman B, Gallagher C et al. DaxibotulinumtoxinA for Injection for the Treatment of Gabellar Lines: Results from Each of Two Multicenter, Randomized, Double Blind, Placebo-Controlled, Phase 3 Studies (SAKURA 1 and SAKURA 2). Plast Recontrc Surg. (2020) 145(1):45-58.
7. Fabi S, Cohen J, Green L, Dhawan S, Kontis T, BaumannL et al. DaxibotulinumtoxinA for Injection for the Treatment of Gabellar Lines: Efficacy Results from SAKURA 3, a Large, Open-Label, Phase # Safety Study. Derm Surg. (2020) 47(1):48-54.