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Jan 17

Scott Sattler MD

Xeomin hits the US market to complete the neurotoxin triad

by Scott Sattler MD

Xeomin hits the US market to complete the neurotoxin triad

After years of total market dominance, Botox (Allergan) now has two rivals – Dysport (Medicis) and now Xeomin (Merz). Each company also has its own HA filler – so the stage is set for real market competition that can only drive down prices for these products – ultimately the consumer will benefit from the expansion of the neurotoxin market.

Speaking with my sources, Xeomin was approved briefly in 2012 and then pulled off the market after a spat with Allergan regarding marketing tactics. Now Xeomin is available for cosmetic use. More info on the shenanigans here.

Back to Xeomin – The low-down from the package insert: Its packed in 50 and 100 unit vials. The efficacy trials for glabellar line treatment are interesting to read. The recommended dosing is 20 units for glabella. This is the same dosing used for the glabellar line studies as well. At day 30, only 65% and 55% of subjects (two seperate multi-center trials were done) reported a 2 grade improvement in glabellar frown line appearance (scale of 1 to 4 or none/mild/moderate/severe). At the 60 day mark, improvement was seen in an even smaller subset of patients.

From a patient satisfaction perspective, I find this concerning – the recommended dose of Xeomin was likely too small in a number of these patients. Just about everybody should be exhibiting marked improvement of glabellar lines at 30 days, and even 60 days.

My Botox patients would be disappointed with this amount of treatment longevity and inconsistancy. A quality neurotoxin treatment that a patient pays $ 300-500 for should be consistent and last for several months

Speaking with a knowledgeable source yesterday, I learned that Xeomin’s concentration (0.44 ng/mL) of actual neurotoxin protein is substantially less than Botox (.73 ng/mL), or even Dysport (0.64ng/mL). 

So what does this mean ?  - in a mL of Xeomin, there is less bioactive material then in a mL of Botox. You’re likely getting more bio-activity per unit volume with Botox then you are with Dysport or Xeomin.

In summary, I’m not convinced that Xeomin is bringing much to the market here. Injectors will probably have to use more Xeomin units to get a good and long lasting treatment effect. This will bump up treatment cost unless Xeomin comes in substantially below cost compared to Botox.

In summary, I’m sticking with what I’m familiar with. Botox is a great neurotoxin, and should last 4-5 months when appropriately dosed based on an individual patient’s anatomy.

Give us a call at 425-776-0880 to schedule a Botox treatment with Dr. Sattler

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