Revance Therapeutics Inc, a biotechnology company focused on innovative aesthetic and therapeutic offerings, including its next-generation neuromodulator product, DaxibotulinumtoxinA for Injection, announces results for two Phase 2a open-label, dose escalation studies of its investigational drug candidate DaxibotulinumtoxinA for Injection in the treatment of dynamic forehead lines (FHL) following glabellar (frown) line injections and lateral canthal lines (LCL), commonly known as crow’s feet.

Both studies demonstrated positive efficacy results, and DaxibotulinumtoxinA for Injection was well tolerated, according to the company in a media release. Additionally, the studies evaluated a range of doses and while not powered to provided clinical significance, they provided directional guidance on the impact of dose on efficacy and duration of effect.   

In the forehead lines study, a total of 61 subjects were randomized into one of four dose groups with each receiving 40 units of DaxibotulinumtoxinA for Injection in the glabellar complex, followed 2 weeks later by injections of either 12, 16, 24, or 30 units in the forehead for a total study duration of up to 38 weeks.  In the crow’s feet study, a total of 63 patients were randomized into one of four dose groups to receive either 12, 24, 36 or 48 units of DaxibotulinumtoxinA for Injection, then followed for up to 36 weeks. 

TREATMENT EFFECT

The primary endpoint for efficacy was the portion of subjects achieving a score of none or mild in wrinkle or line severity at Week 4 either at maximum eyebrow elevation for forehead lines or at maximum smile for crow’s feet. The scores were based on the investigator assessment.  In the forehead lines study, 100% of subjects achieved a score of none or mild at Week 4 in at least one treatment group. In the crow’s feet study, 88% of subjects achieved a score of none or mild at Week 4 in at least one treatment group.

In addition, the proportion of subjects with a measurable treatment effect, as assessed by the investigator, was analyzed. A dose-dependent change in percent of subjects with at least a one-point change from baseline was observed. In both studies, 100% of subjects achieved a score of at least a one-point change from baseline at Week 4 in at least one treatment group.

One of the exploratory endpoints in these studies was duration of effect, defined as the median time to return to baseline wrinkle severity based on both investigator and patient assessment.  At least one dose in each study demonstrated a median duration of effect of 27 weeks in the forehead lines study and 24 weeks in the crow’s feet study. 

SAFETY

In these two Phase 2a studies, DaxibotulinumtoxinA for Injection was well-tolerated at all dose levels. Adverse events were mild, localized and transient as expected and there were no treatment-related serious adverse events, as is common with other approved neuromodulators in the treatment of facial lines. The most common treatment-emergent adverse events after forehead line treatment were edema (10%), erythema (6.7%) and headache (5%). There was as single occurrence of mild eyelid ptosis that was fully resolved by Day 9. The most common treatment-emergent adverse events after crow’s feet treatment were nasopharyngitis (11.1%), bruising (7.9%) and headache (7.9%). There were no events of ptosis.

ADJACENT STUDIES

Interim Week 4 data from these two Phase 2a studies were used in the final design of Revance’s current upper facial lines Phase 2 study (glabellar lines, forehead lines and lateral canthal lines), to optimize dosing and injection patterns. Revance is scheduled to report results from that study in the fourth quarter of 2020. The SAKURA Phase 3 program assessing DaxibotulinumtoxinA for Injection as a potential treatment for moderate to severe glabellar lines yielded positive results, and the subsequent submission for regulatory approval has been given a Prescription Drug User Fee Act (PDUFA) VI program date of November 25, 2020, by the U.S. Food and Drug Administration (FDA).

“We are very pleased with the results of these two studies, designed to evaluate safety and efficacy, as well as identify safe and effective doses, for DaxibotulinumtoxinA for Injection in the treatment of forehead lines and crow’s feet. The finding that at least one dose in each study produced a response rate of 24-weeks duration provides a compelling initial demonstration that DaxibotulinumtoxinA for Injection holds promise for the treatment of forehead lines and crow’s feet.” 

— Roman Rubio, MD, Senior Vice President of Clinical Development at Revance

“Exploring DaxibotulinumtoxinA for Injection in other areas of the upper face beyond glabellar lines provides an expanded body of knowledge on the performance of our long-acting, next-generation neuromodulator. These results are consistent with those observed in our SAKURA Phase 3 program for DaxibotulinumtoxinA for Injection in the treatment of glabellar lines. Our aim is to provide physicians and patients with a true advancement in the treatment of not only facial wrinkles, but also a number of debilitating muscle movement and pain disorders, which are being addressed through ongoing therapeutic clinical trials.” 

— Mark Foley, President and Chief Executive Officer, Revance

Phase 2a Clinical Program in Forehead Lines

The company’s Phase 2a clinical program was a multicenter, open-label, dose escalation study to evaluate treatment of moderate or severe dynamic forehead lines (FHL) (frontalis) in conjunction with treatment of the glabellar complex. The study was conducted at four sites in the United States and Canada and enrolled 61 male and female patients with moderate to severe FHL, from the ages of 18 to 65 years old.  Patients were enrolled sequentially into 1 of 4 treatment cohorts to receive DaxibotulinumtoxinA for Injection at 1 of 4 dose levels, ranging from 12 to 30 Units. At the Day 1 study visit, patients received a single 40 U dose of DaxibotulinumtoxinA for Injection for the treatment of glabellar lines. At the Week 2 study visit, patients received the assigned dose of DaxibotulinumtoxinA for Injection for the treatment of forehead lines. The total study duration was 38 weeks, plus up to 2 weeks for screening. Patients were then followed for a minimum of 24 weeks.

Phase 2a Clinical Program in Lateral Canthal Lines

The company’s Phase 2a clinical program was a multicenter, open-label, dose escalation study that evaluated treatment of moderate or severe lateral canthal lines (LCL) or crow’s feet. The study was conducted at three sites in the United States and enrolled 63 male and female patients with moderate to severe lateral canthal lines, from the ages of 18 to 65 years old.  Patients were enrolled sequentially into 1 of 4 treatment cohorts to receive DaxibotulinumtoxinA for Injection at 1 of 4 dose levels, ranging from 12 to 48 Units. The total study duration was up to 36 weeks, plus up to 2 weeks for screening. Patients were then followed for a minimum of 24 weeks.

Additional information about each Phase 2a study can be found at www.clinicaltrials.gov.

[Source: Revance Therapeutics Inc]


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