Medscape is running a useful and informative CME presentation about neurotoxins in general and Dysport/Botox Cosmetic in particular. The lecturer, Gary D. Monheit, MD, opens with the interesting history of botulinum toxin, proceeds to describe the science underlying the botulinum molecule itself and the subtypes, and goes through the clinical trials and tips/cautions for proper use of the neurotoxins. You can either listen to his lecture or read the transcript.

From Monheit's opening remarks:

"What's the ideal neurotoxin?" What kind of properties would we want if we could choose the very best? We would like something that acts rapidly. We would like a molecule that has stable pharmacologic action throughout its whole time of activity. We want the toxin effect limited to the muscle sites -- limited yet controlled diffusion. We have to have some diffusion in order to affect the muscles we're treating. [We want] few drug-related side effects, such as pain, flu-like symptoms, unwanted areas treated. We want a natural appearance. It needs to be physiologic, and we would like a prolonged action -- hopefully 6 months or greater. None of our toxins have all of these properties today; maybe someday we'll see it.

Here are the toxins that are on the market [and in development]. In the United States we have Botox® and Dysport®. There are other toxins in the world that are not approved, such as a Korean toxin, a Chinese toxin, and some that are under investigation in the United States. PurTox® is being investigated by the Mentor Corporation for FDA approval, and Xeomin® by the Merz Corporation. Both of those are bare neurotoxin molecules without complexes. Myobloc® is a different toxin. It's a type B toxin and presently isn't being used for cosmetic reasons. Another exciting neurotoxin on the horizon...is a topically applied neurotoxin with absorption through the skin.

Read it all.

Well-known health care pundit David Phillips expresses his satisfaction with Johnson & Johnson's recently launched Stelara for the treatment of adult patients with moderate to severe plaque psoriasis. He notes that the new prodct is a "first-in-class interleukin (IL) inhibitor" and a "novel and less cumbersome injectable than established biologics for psoriasis, the tumor necrosis factor-alpha inhibitors."

Although the article careens immediatley into a fulsome analysis of how this product may do well in the marketplace, there is something to take away from his perspective on Stelara's medical aspects, and its implications for the cosmetic surgery field. Why J&J's Stelara Launch Should Target Dermatologists First:

An overactive immune system can also trigger high levels of IL-12 and IL-23, two proteins found in the red scaly skin patches characteristic of psoriatic plaques. Stelara (ustekinumab) is a novel monoclonal antibody that binds to IL-12 and IL-23, thereby slowing the overproduction of skin cells and the resultant inflammation (see image to left; click for a larger version).

The actual size of the psoriasis market is deceptive in terms of market size and sales potential. Epidemiological studies have shown that as patients age their risk of developing co-morbid autoimmune diseases, such as the GI disease Crohn’s, rheumatoid arthritis, and psoriatic arthritis, increases, too.

Overlapping pathogenic pathways in autoimmune diseases have not been lost on the makers of the three major TNF-alpha blockers. Amgen, Abbott Labs, and J&J understand the dynamics of brand positioning. With diversified FDA-approved product labeling — from the relatively uncommon spinal arthritic condition, called ankylosing spondylitis, to the more familiar psoriasis, psoriatic or rheumatoid arthritis — the drug makers have successfully sold specialists (in particular, gastroenterologists and rheumatologists) on the clinical utility of prescribing TNF inhibitors across a range of prominent autoimmune diseases...

Philips cuts to the chase further down in the story, in which he writes, "Stelara, like all existing autoimmune-modifying biologics on the market, can increase the risk of opportunistic infections in those patients hosting latent viruses or bacterium."

He also notes pricing and marketing concerns. For example, the average wholesale price of Stelara is $5,595.60 per 45mg/0.5 ml vial, according to CVS Caremark" -- a competitive price, says Phillips.

The new report also suggested that dermatologists are more readily moving patients from first-line topical corticosteroids to second-line conventional systemic agents and foregoing additional lines of topical treatment in the process.

Read it all.