It has finally happened….a competitive alternative to Botox for cosmetic facial wrinkle reduction has been approved by the FDA. Last week, The FDA put its stamp of approval on the boulinum toxin A drug Dysport. (had been known as Reloxin) This was anticipated since January when an FDA panel gave it a preliminary nod. Dysport has been used for some time in Europe and other countries so its formulation is not new. Actual distribution will begin in 30 days or so. Because of training requirements and a pent up demand, Dysport vials probably won’t start to flow and become widely available until mid-summer.
As the first (and surely not the last) major competitor to Botox, how does Dysport compare in clinical performance? The information from pre-approval clinical trials indicates that it is just as effective as Botox in facial muscle reduction and lasts the same month of time, around 4 months. Its one advantage is that its onset is quicker, occurring within a day or two rather than a week. This buys the patient an extra week of results for the same price so to speak. Unit dosages are different between the two so they cannot be compared by what we know now as a ‘Botox unit’.
In a 2006 Dermatology journal report, a clinical study compared Botox and Dysport. At a 2.5:1.0 unit Dysport:Botox ratio, Botox was more effective for wrinkle treatment. In a previous study cited by the same authors, a 4:1 ratio produced similar results, but the patients receiving Dysport had more adverse effects. To me this means that the proper use of Dysport will involve a learning curve even for experienced Botox injectors, which will slow its wide acceptance unless the cost difference significantly favors Dysport.
Dysport’s biggest advantage, therefore, will likely be its price. I am assuming that the quickest way to take a significant share of Botox’s market is to undercut it in price. Botox, because of its long-term monopoly on the market, has had ongoing price increases over the years and is not known for its service in many geographic regions. There are definitely significant numbers of physicians as a result that can’t wait to jump ship and use a competitor. Botox will undoubtably respond quickly by lowering its price. Where the price points and treatment costs will settle out for both is unknown at this point. But the patient is likely to be a winner in this scenario because of the stiff competition that will ensue.
Dr. Barry Eppley