Before we even get into the granular detail let me make clear that Daxxify is a very promising product and will likely be of use to many patients. Its new formula seems to last longer and could work with people who have built up a tolerance to regular Botox. However, it has its own shortcomings which we’ll explore in depth.

How Does Daxxify Work and What Makes it Different?

Like other neurotoxins used for injections, Daxxify works by interfering with acetylcholine channels, which are necessary to communicate between nerves and muscles that create wrinkles. Daxxify uses an artificially produced peptide instead of human protein to penetrate into the cell, which results in increased blocking power and a longer effect. This is the main reason for its longer-lasting effect. Another benefit might be that it will work on patients who have built a tolerance to Botox and other neuromodulators that uses human protein as its binding protein.

However, it is essential to look at the actual scientific evidence behind Daxxify to see if the hype is worth it. At the time of writing this article, there are five studies investigating Daxxify for glabellar wrinkle injection. One of the studies looked at the actual dosing of Daxxify, and this is where things get tricky. Each product that uses Botulinum Toxin A (BoNTA) has a slightly different toxin amount per unit due to the manufacturing process. For example, 20 units of Type A does not equal 20 units of Type B or Type C. Therefore it is impossible to simply compare products based on their units. A more scientific way to compare BoNTA products is by comparing the mass of core neurotoxin at a given dose for each.

Going back to the literature behind Daxxify the investigators found that 40 units of Daxxify have a similar mass core neurotoxin as 20U of Botox. Further, the results showed that 40U Daxxify achieved similar satisfaction to 20 units of Botox for the treatment of glabellar wrinkles but lasted a lot longer up to 24 weeks.

It is impossible to simply compare products based on their units

Graph showing the effect of 20U of Botox compared to 20U, 40U and 60U of Daxxify.

The results are measured in glabellar wrinkle lines after weeks of injection.

The bottom blue line depicts an injection with a Placebo that has no effect on wrinkles.

Is Daxxify Better?

From an efficacy level, Daxxify is likely better. The question is whether it is a better product for the patient. Daxxify will probably be priced higher than other products, and more units will be needed to achieve the desired longer-lasting effect. One thing to keep in mind with longer-lasting results is the rare occasion where you are not happy with the treatment. BoNTA cannot be reversed once injected. Although adverse events are rare, some patients are unhappy with the effect of neurotoxin injections, and the only solution is to wait until it wears off. The manufacturers always recommend not combining different products. Therefore, if a patient is unhappy with their Daxxify treatment, they will likely need to wait a lot longer than with other products.

Moreover, if the baseline price per unit is more expensive, it will be overall more expensive for patients.

The bottom line

In conclusion, it will ultimately come down to the patients and the price, if Daxxify will take the injectable market by storm or just becomes another alternative to the already established players. Patients who prefer to get injected once or twice a year, and trust the results of their injectors will probably be excellent candidates for Daxxify, assuming they do not mind the likely higher price point. Fewer injections ultimately could mean money saved so we will have to wait a little longer until we know.

References

• Carruthers JD, Fagien S, Joseph JH, Humphrey SD, Biesman BS, Gallagher CJ, et al. DaxibotulinumtoxinA for Injection for the treatment of glabellar lines: results from each of two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). Plast Reconstr Surg. 2020;145(1):45–58. https://doi.org/10.1097/PRS.0000000000 006327.

• Carruthers J, Solish N, Humphrey S, Rosen N, Muhn C, Bertucci V, et al. Injectable DaxibotulinumtoxinA for the treatment of glabellar lines: a phase 2, randomized, dose-ranging, double-blind, multicenter comparison with onabotulinumtoxinA and placebo. Dermatol Surg. 2017;43(11):1321–31. https://doi.org/10.1097/ DSS.0000000000001206.

• Fabi SG, Cohen JL, Green LJ, Dhawan S, Kontis TC, Baumann L, et al. DaxibotulinumtoxinA for Injection for the treatment of glabellar lines: efcacy results from SAKURA 3, a large, openlabel, phase 3 safety study. Dermatol Surg. 2021;47(1):48–54. https://doi.org/10.1097/dss.0000000000002531.

• Garcia-Murray E, Velasco Villasenor ML, Acevedo B, Luna S, Lee J, Waugh JM, et al. Safety and efcacy of RT002, an injectable botulinum toxin type A, for treating glabellar lines: results of a phase 1/2, open-label, sequential dose-escalation study. Dermatol Surg. 2015;41(Suppl 1):S47-55. https://doi.org/10.1097/DSS. 0000000000000276.

• Bertucci V, Solish N, Kaufman-Janette J, Yoelin S, Shamban A, Schlessinger J, et al. DaxibotulinumtoxinA for Injection has a prolonged duration of response in the treatment of glabellar lines: Pooled data from two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). J Am Acad Dermatol. 2020;82(4):838–45. https://doi.org/10. 1016/j.jaad.2019.06.1313.

• Green JB, Mariwalla K, Coleman K, Ablon G, Weinkle SH, Gallagher CJ, et al. A large, open-label, phase 3 safety study of DaxibotulinumtoxinA for Injection in glabellar lines: a focus on safety from the SAKURA 3 study. Dermatol Surg. 2021;47(1):42–6. https://doi.org/10.1097/dss.0000000000002463.

• Bertucci V, Humphrey S, Carruthers J, Solish N, Muhn C, Swift A, et al. Comparing injectable daxibotulinumtoxinA and onabotulinumtoxinA in moderate and severe glabellar lines: additional analyses from a phase 2, randomized, dose-ranging, double-blind, multicenter study. Dermatol Surg. 2017;43:S262–73. https://doi. org/10.1097/DSS.0000000000001364.