In February of 2019 the US Federal Drug Administration (FDA) licenced the use of Jeuveau for the “temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adult patients”. By doing so it has positioned itself to directly compete with Botox.
The drugs are very similar and act in an identical manner. Botox is Botulinum toxin as derived from the bacterium Clostridium botulinum. It acts by blocking the release of acetylcholine, a molecule released by motor neurons that run between the spinal cord and muscles. Acetylcholine interacts with the muscles making them contract. By blocking acetylcholine release Botox paralyses the muscle and temporarily eliminates the appearance of wrinkles.
The active molecule in Jeuveau is prabotulinumtoxinA-xvfs which is again obtained from Clostridium botulinum and functions in the same manner as Botox. However, Jeuveau costs 25% less than Botox. It is unclear how Evolus are able to produce Jeuveau so it’s so much cheaper but it may be related to their focus on the cosmetic market that would allow for savings in the manufacturing process as the final product subject to fewer regulations and may require less testing against government standards.
Whereas Jeuveau is strictly cosmetic in function Botox and other neurotoxins have been used therapeutically. Treatments include lazy eye, neck spasms, and preventions of migraine. The mechanism of action is the same as the cosmetic use but the injection site targets the location of action.
Naturally, the botulism toxin is used by the bacterium as part of it’s defence mechanism. It is largly responsibly for the effects of poisoning by botulism. These effects include drooping of eyelids, cramps, breathing and swallowing difficulties and paralysis. Because the molecule is largely unchanged there is some potential for toxic effects to occur when used cosmetically. Jeuveau and Botox have a similar level of toxicity. Evolus have made a point of emphasising this in their marketing as a justification for their claim that Jeuveau can be used interchangeably with Botox.
Early Jeuveau sales have been promising. In the first 90 days revenue from Jeveua was $2.1 million from 5,000 unit sales. This supposedly exceeded Evolus’s projections of 3,000 units. Despite this Evolus net loss increased in the same period of time to $37.57 million, likely due to a major marketing push driving up costs. In contrast to Jeuveau, Botox achieved sales of $974 million in the same period. Botox may still be the king for at least a little while longer.
