The emergence of new formulations of botulinum toxin and other neuromodulators in the pipeline awaiting approval by the Food and Drug Administration signal a need for clinicians to stay abreast of the various uses and potential adverse events.
Since the start of its therapeutic use in the medical arena decades ago, the utilities for botulinum toxin have been expanding for clinical as well as cosmetic indications.
“Botulinum toxin has shown to be a very useful therapeutic tool in medicine employed for the treatment of varying indications including eye disorders, pain and neuromuscular disorders, but perhaps its most popular applications are seen in the field of aesthetic medicine for the treatment of frown lines,” says Alastair Carruthers, M.D., clinical professor, department of dermatology and skin science, Vancouver, British Columbia. “Despite its extensive use for numerous medical and aesthetic indications, I believe that we have only scratched the surface of its potential.”
Currently, four botulinum toxin serotype A (BoNTA) and B (BoNTB) formulations are approved by the FDA, namely onabotulinumtoxinA (Botox, Allergan), abobotulinumtoxinA (Dysport, Medicis), incobotulinumtoxinA (Xeomin, Merz) and rimabotulinumtoxinB (Myobloc, Solstice Neurosciences). Of these, the BoNTA preparations are the most widely used worldwide and the only ones FDA-approved for aesthetic use.
Bright future
The future of botulinum toxin therapies is very exciting, as new and innovative toxin delivery modalities are developed, such as the topical RT001 cream (Revance Therapeutics), which has yet to be approved by the FDA. This uncomplexed BoNTA topical product has been shown to traverse intact skin and achieve a result, Dr. Carruthers says, that could open doors for novel clinical applications, such as the reduction of redness, oiliness and sweating after a brief application of the neurotoxin.
“A topical neurotoxin that can target the sweat glands, sebaceous glands and vasculature could help to treat numerous dermatologic conditions. Although I don’t think that this is going to significantly impact the injectable market, such a topical modality may expand the market dramatically,” Dr. Carruthers says.
Injectable neurotoxins have been shown to be effective in the treatment of headaches and migraines, and topical neurotoxin products such as Revance have also been shown to improve this condition, representing a novel treatment option for patients.
Other evolving indications for neurotoxin therapy in medicine could be the treatment of depression. According to Dr. Carruthers, there is an increasing number of studies being reported demonstrating that the use of botulinum toxin in frown lines can help improve depression in many affected individuals. Other changes being made to the botulinum toxin molecule could result in radical changes in the treatment of pain syndromes in the future. Novel neurotoxin formulations in the works could significantly help alleviate the pain typically associated with those syndromes, he says.
“I have had experience with all of the available neurotoxins and though there are fine differences among them, I find them all to be effective. As we get to know these products better and learn from personal experiences and future studies, we may begin to distinguish areas for which one may be more suitable than the other for a given indication,” Dr. Carruthers says.
This news is brought to you courtesy of Dr. Mark Bishara and The Paragon Surgery & Med Spa