Is A Longer Lasting Botox On The Horizon?

Botox works like a miracle and there is no question about it, but the most common complaint it raises in aesthetic clinics is: why do my results last only three to five months and I have to come back three times a year to get my neuromodulator injections? Isn’t there something better that lasts longer? We're all looking for a longer-lasting type of neurotoxin.

A current topical neuromodulators in the pipeline uses peptide molecules to transport the active molecule through the skin; the product is called Revance. To analyze product safety FDA asked the company a question: what happens in the long-term when product’s carrier peptide is absorbed by the body?

To find out, the company conducted a small safety trial in which investigators injected the topical neuromodulator and peptide combination. "It worked," with 67 percent of patients achieving two-point investigator-assessed improvements in glabellar frown lines.

These results were no surprise, because the Botulinum toxin by itself should work well. The exciting part was that it works longer.

In previous mouse studies, it took 15.8 weeks for the neuromodulator alone to wear off completely, versus 31.6 weeks for the neuromodulator and peptide combination. In a phase 1/2 clinical trial of RT002 (Revance), for the average patient, it took almost 30 weeks for the effect of the drug to wear off. With any of the commercially available neurotoxins, it's very rare to see results last that long.

Like many medical breakthroughs, this is an accidental discovery. Nobody believed that this protein carrier peptide would have any effect when injected.

Why does the combination last longer, when it uses the same 150 kDa Botulinum toxin a molecule that's in all the currently FDA-approved neuromodulators? Logically the only thing the company was able to find was that adding the peptide reduced diffusion by about 50 percent. So more of the drug stays where you want it.