Featured experts
Dr. Connie Yang, a board-certified dermatologist in New York City
Dr. Ellen Marmur, a board-certified dermatologist in New York City
Dr. Sue Ellen Cox, a board-certified dermatologist in Chapel Hill, North Carolina
It wasn’t all that long ago that Botox was the only injectable neurotoxin out there. Granted, it still holds the majority stake in the market—and has the greatest name recognition. So much so that the brand name is often (incorrectly) used to refer to any type of neuromodulator, akin to calling all tissues Kleenex. But there’s a growing number of competitors out there: Dysport, Jeuveau, Xeomin, and Daxxify.
Now there’s another one joining that list. Letybo recently received FDA approval and should be available later this year. What sets Letybo apart from its counterparts? Here’s what doctors have to say.
What is Letybo?
“Letybo is the brand name for another botulinum toxin A, the same type of botulinum found in all the other neuromodulators,” explains Dr. Connie Yang, a board-certified dermatologist in New York City. Worth noting: Letybo has long been available in other countries and is actually the leading neurotoxin in South Korea, she adds. According to New York City board-certified dermatologist Dr. Ellen Marmur, this adds to Letybo’s credibility. “I love that it’s been used worldwide for more than seven years, because I’m always wary about trying anything from overseas. But this has a long history of safety—which is always of utmost importance,” she points out.
How does Letybo differ from other neurotoxins?
Long answer short: it doesn’t, really. “All of these products are more similar than they are different, and there really isn’t one specific differentiating factor for Letybo in particular. It’s more of a ‘me too’ product,” says Dr. Sue Ellen Cox, a board-certified dermatologist in Chapel Hill, North Carolina, an investigator in Letybo’s clinical trials. “It’s going to work just as well as Botox, but we’re not going to see a big difference when it comes to patients being able to distinguish it from the other neuromodulators,” she says.
As mentioned, all the injectable neurotoxins currently FDA approved for cosmetic use feature botulinum toxin A and work via the same mechanism of action—inhibiting the release of acetylcholine, a neurotransmitter that’s responsible for muscle movement, explains Dr. Yang. (Myobloc, which uses botulinum toxin B, is currently FDA approved only for medical indications.)
Where they differ—at least from the standpoint of their molecular makeup—is the use of additional proteins meant to stabilize the botulinum toxin. For example, Xeomin doesn’t contain any of these, which is why it’s sometimes referred to as the ‘naked tox.’ Daxxify made news for utilizing a peptide that works like a magnet, helping the botulinum toxin better “stick” to the neurosynaptic junction. (This is why Daxxify initially claimed a much longer duration, but more on that in a moment.) Letybo contains fewer of these complexing proteins, notes Dr. Marmur. Why is that important? The proteins are targets for the antibodies that ultimately cause the neurotoxin to stop working. Fewer targets means it could last a little bit longer, she says. At least, theoretically…
Does Letybo kick in faster or last longer than other neurotoxins?
Again, not really. “From the data I’m seeing, Letybo supposedly kicks in within two to three days,” says Dr. Yang. This is faster than Botox’s average onset of five to seven days but in line with how quickly Dysport starts to work. As far as duration goes, Dr. Marmur says it should last 12 to 16 weeks, perhaps a few weeks longer than some of its competitors but still fairly comparable. [Worth noting: Daxxify’s big point of differentiation at launch was increased longevity. The brand claimed six months, although patients and doctors alike now agree that this was a bit overhyped. Dr. Cox notes that only about 50% of her Daxxify patients find that it lasts longer. It’s very patient dependent, agrees Dr. Marmur.]
So do we really need another neurotoxin?
All the doctors we spoke with agree that adding another neuromodulator into the mix is ultimately a good thing, for provider and patient alike. While the options out there are very similar, patients may notice subtle nuances among them and like one more than another, says Dr. Cox. Letybo offers yet another choice to try. The other advantage? More competitive pricing for consumers and the doctors purchasing these products, says Dr. Marmur.
“As providers introduce Letybo into their Rolodex, this will likely spur even more competition in the market, particularly as it pertains to innovation,” says Dr. Yang. Dr. Marmur echoes this sentiment, adding that it will continue to inspire more research on neuromodulators, in both the medical and cosmetic fields. To that point, Letybo is likely only the first of several new neurotoxins to come. “I’ve completed clinical trials for at least three neuromodulators recently, and I know that there have been a few more that I haven’t been a part of,” says Dr. Cox.
As far as exactly where Letybo fits into the existing portfolio of neurotoxins remains to be seen. “It’s always exciting to have a new product, but only time will tell what exact benefits, if any, it will have that differentiate it from the options already available,” Dr. Yang points out.
