While BOTOX® Cosmetic (onabotulinumtoxinA) has become a household name, BOTOX® was the first botulinum toxin type A treatment to be approved by the U.S. Food and Drug Administration as an orphan drug for two rare, eye muscle disorders. This journey, which started in 1989, began with the approval of BOTOX® to treat strabismus (a misalignment of the eyes, commonly known as crossed eyes) and blepharospasm (uncontrolled blinking of the eyelid). Strabismus affects nearly four in every 100 adults,1 and blepharospasm affects an estimated 20,000 to 50,000 people in the United States, with 2,000 new cases diagnosed annually.2 Since that time, BOTOX® therapeutic has been approved for other significant medical conditions including Cervical Dystonia, Severe Underarm Sweating when topical agents don’t work sufficiently, Upper Limb Spasticity, Chronic Migraine, Overactive Bladder when an anticholinergic doesn’t work or the side effects are intolerable, and urinary incontinence due to overactive bladder caused by a neurologic condition when an anticholinergic doesn't work or the side effects are intolerable.
“BOTOX® is an innovative product whose potential to treat medical conditions across a variety of therapeutic categories continues to expand even today,” said David E.I. Pyott, Chairman of the Board and Chief Executive Officer, Allergan. “The more we research the medical value of this treatment, the more we learn about this biologic and the areas of clinical unmet need where it may provide some benefit. Since BOTOX® was first approved 25 years ago, the list of indications it treats has grown exponentially – not just in the United States, but globally. Today, physicians in 88 countries treat 27 different conditions with BOTOX® and the possibilities continue to grow with Allergan’s research.”3
The video, which outlines the 25-year history of development for BOTOX® therapeutic, features first-hand accounts from patients who chronicle their journey from diagnosis to treatment, as well as physicians who share their personal experiences in advancing the development of this brand, showcasing its therapeutic roots.
For each person that views the video, Allergan will support four patient advocacy organizations that are partnering with the company to help raise awareness, educate and support people living with any of the medical conditions currently being treated with BOTOX®. Support will be given to:
- Benign Essential Blepharospasm Research Foundation (BEBRF)
- Dystonia Medical Research Foundation (DMRF)
- National Headache Foundation (NHF)
- National Association for Continence (NAFC)
“The history of BOTOX® therapeutic is really a remarkable story of how a substance from nature has been successfully harnessed for medical benefit,” said Scott Whitcup, M.D., Allergan’s Executive Vice President, Research and Development and Chief Scientific Officer, “It’s also a human interest story that starts with the scientists and the physicians who observed the impact of BOTOX® in treating certain medical conditions, tracked that impact and did something about it. Without this pioneering spirit, we would not have been able to pursue the clinical development and FDA approval of many of the therapeutic indications we now have for BOTOX®.”
To learn more about BOTOX® and to view the 25th anniversary video please visit www.BOTOX.com.
About BOTOX® (onabotulinumtoxinA)
BOTOX® is a prescription-only medical product that contains tiny amounts of a highly purified botulinum toxin protein refined from the bacterium, Clostridium botulinum. When injected at doses approved by the U.S. Food and Drug Administration (FDA) into a specific muscle or gland, BOTOX® neurotoxin is expected to produce a safe, as well as effective result, usually lasting up to approximately three to ten months, depending on the approved indication and on the individual patient.
BOTOX® was first approved in 1989 by the U.S. Food and Drug Administration (FDA) for the treatment of two eye muscle disorders, making it the first botulinum toxin type A product to be approved in the world. Since then, BOTOX® has been recognized by regulatory authorities as an effective treatment for 27 different indications in approximately 88 countries, benefiting patients worldwide.
Today, BOTOX® neurotoxin is approved to treat a total of eight medical conditions in the United States, including:
- the treatment of overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken;
- the treatment of leakage of urine (incontinence) in adults 18 years and older with overactive bladder due to neurologic disease who still have leakage or cannot tolerate the side effects after trying an anticholinergic medication;
- the prevention of headaches in adults with chronic migraine who have 15 or more days each month with headache lasting four or more hours each day in people 18 years or older;
- the treatment of increased muscle stiffness in elbow, wrist, and finger muscles in people 18 years and older with upper limb spasticity;
- the treatment of the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older;
- the treatment of certain types of eye muscle problems (strabismus) in people 12 years and older;
- the treatment of abnormal spasm of the eyelids (blepharospasm) in people 12 years and older; and
- the treatment of symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.
Please see full Indications and Important Limitations below
In addition to the BOTOX® therapeutic uses, BOTOX® Cosmetic with dosing specific for aesthetic patients has been approved by the FDA. BOTOX® Cosmetic is injected into muscles and used to temporarily improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) and moderate to severe crow’s feet lines in adults.
Over the past 23 years, approximately 47 million vials of BOTOX® and BOTOX® Cosmetic have been distributed worldwide (1990-2013).4 In addition, the safety and efficacy of BOTOX® have been well-established in approximately 78 randomized, placebo-controlled clinical trials and in approximately 17,000 patients treated with BOTOX® and BOTOX® Cosmetic in Allergan’s clinical trials.5 With approximately 2,800 articles on BOTOX® and BOTOX® Cosmetic published in scientific and medical journals,6 BOTOX® neurotoxin is one of the most widely researched medicines in the world.
BOTOX® (onabotulinumtoxinA) & BOTOX® Cosmetic (onabotulinumtoxinA) Important Information
BOTOX® is a prescription medicine that is injected into muscles and used:
- to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken.
- to treat leakage of urine (incontinence) in adults 18 years and older with overactive bladder due to neurologic disease who still have leakage or cannot tolerate the side effects after trying an anticholinergic medication
- to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older
- to treat increased muscle stiffness in elbow, wrist, and finger muscles in people 18 years and older with upper limb spasticity
- to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older
- to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older
BOTOX® is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.
BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults younger than 65 years of age for a short period of time (temporary).
BOTOX® Cosmetic is a prescription medicine that is injected into the area around the side of the eyes to improve the look of moderate to severe crow’s feet lines in adults for a short period of time (temporary).
It is not known whether BOTOX® and BOTOX® Cosmetic are safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).
It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper-limb muscles other than those in the elbow, wrist, and fingers, or to treat increased stiffness in lower-limb muscles. BOTOX® has not been shown to help people perform task-specific functions with their upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. Treatment with BOTOX® is not meant to replace your existing physical therapy or other rehabilitation that your doctor may have prescribed.
It is not known whether BOTOX® and BOTOX® Cosmetic are safe or effective for severe sweating anywhere other than your armpits.
IMPORTANT SAFETY INFORMATION
BOTOX® and BOTOX® Cosmetic may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® or BOTOX® Cosmetic:
- Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
- Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing. If this happens, do not drive a car, operate machinery, or do other dangerous activities
There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, strabismus, or when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines or crow’s feet lines.
Do not take BOTOX® or BOTOX® Cosmetic if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.
Do not take BOTOX® for the treatment of urinary incontinence if you: have a urinary tract infection (UTI) or cannot empty your bladder on your own and are not routinely catheterizing.
Due to the risk of urinary retention (not being able to empty the bladder), only patients who are willing and able to initiate catheterization post-treatment, if required, should be considered for treatment.
Patients treated for overactive bladder
In clinical trials, 6.5% of patients (36/552) initiated clean intermittent catheterization for urinary retention following treatment with BOTOX® 100 Units as compared to 0.4% of patients (2/542) treated with placebo. The median duration of catheterization for these patients treated with BOTOX® 100 Units was 63 days (minimum 1 day to maximum 214 days) as compared to a median duration 11 days (minimum 3 days to maximum 18 days) for patients receiving placebo.
Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than non-diabetics.
Patients treated for overactive bladder due to neurologic disease
In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of post-injection catheterization for these patients treated with BOTOX® 200 Units (n=33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n=7).
Among patients not using CIC at baseline, those with MS were more likely to require CIC post-injection than those with SCI.
The dose of BOTOX® and BOTOX® Cosmetic is not the same as, or comparable to, any other botulinum toxin product.
Serious and/or immediate allergic reactions have been reported. These reactions include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you experience any such symptoms; further injection of BOTOX® or BOTOX® Cosmetic should be discontinued.
Tell your doctor about all your muscle or nerve conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX® or BOTOX® Cosmetic.
Tell your doctor if you have any breathing-related problems. Your doctor will want to monitor you for any breathing problems during your treatment with BOTOX® for upper limb spasticity or for detrusor overactivity associated with a neurologic condition. The risk of pulmonary effects in patients with compromised respiratory status is increased in patients receiving BOTOX®.
Cornea problems have been reported. Cornea (surface of the eye) problems have been reported in some people receiving BOTOX® for their blepharospasm, especially in people with certain nerve disorders. BOTOX® may cause the eyelids to blink less, which could lead to the surface of the eye being exposed to air more than is usual. Tell your doctor if you experience any problems with your eyes while receiving BOTOX®. Your doctor may treat your eyes with drops, ointments, contact lenses, or with an eye patch.
Bleeding behind the eye has been reported. Bleeding behind the eyeball has been reported in some people receiving BOTOX® for their strabismus. Tell your doctor if you notice any new visual problems while receiving BOTOX®.
Bronchitis and upper respiratory tract infections (common colds) have been reported. Bronchitis was reported more frequently in people receiving BOTOX® for their upper limb spasticity. Upper respiratory infections (common colds) were also reported more frequently in people with prior breathing-related problems.
Autonomic dysreflexia in patients treated for overactive bladder due to neurologic disease Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in patients treated with BOTOX® 200 Units compared with placebo (1.5% versus 0.4%, respectively).
Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles, such as trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence. Symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever; have problems emptying your bladder on your own and are being treated for urinary incontinence; are pregnant or plan to become pregnant (it is not known if BOTOX® or BOTOX® Cosmetic can harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if BOTOX® or BOTOX® Cosmetic passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal products. Using BOTOX® or BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® or BOTOX® Cosmetic in the past.
Especially tell your doctor if you: have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (be sure your doctor knows exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take anti-platelets (aspirin-like products) or anti-coagulants (blood thinners).
Other side effects of BOTOX® and BOTOX® Cosmetic include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes. In people being treated for urinary incontinence other side effects include: urinary tract infection, painful urination, and/or inability to empty your bladder on your own. If you have difficulty fully emptying your bladder after receiving BOTOX® , you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.
For more information refer to the Medication Guide or talk with your doctor.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Allergan is a multi-specialty health care company established more than 60 years ago with a commitment to uncover the best of science and develop and deliver innovative and meaningful treatments to help people reach their life’s potential. Today, we have approximately 11,200 highly dedicated and talented employees, global marketing and sales capabilities with a presence in more than 100 countries, a rich and ever-evolving portfolio of pharmaceuticals, biologics, medical devices and over-the-counter consumer products, and state-of-the-art resources in R&D, manufacturing and safety surveillance that help millions of patients see more clearly, move more freely and express themselves more fully. From our beginnings as an eye care company to our focus today on several medical specialties, including eye care, neurosciences, medical aesthetics, medical dermatology, breast aesthetics and urologics, Allergan is proud to celebrate more than 60 years of medical advances and proud to support the patients and customers who rely on our products and the employees and communities in which we live and work. For more information regarding Allergan, go to: www.allergan.com.
This press release contains “forward-looking statements,” including but not limited to, the statements by David E.I. Pyott and other statements regarding the use of BOTOX®. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize, actual results could vary materially from Allergan’s expectations and projections. Risks and uncertainties include, among other things, general industry and medical device market conditions; challenges related to achieving regulatory approval from the FDA on a timely and cost-efficient manner; technological advances and patents attained by competitors; inconsistency of treatment results among patients; potential difficulties in manufacturing; challenges related to new product marketing, such as the unpredictability or market acceptance for new products and/or the acceptance of new indications for such products; and governmental laws and regulations affecting domestic and foreign operations. Allergan expressly disclaims any intent or obligation to update these forward-looking statements except as required by law. Additional information concerning these and other risks can be found in press releases issued by Allergan, as well as Allergan’s public periodic filings with the U.S. Securities and Exchange Commission, including the discussion under the heading “Risk Factors” in Allergan’s most recent Annual Report on Form 10-K and any subsequent Quarterly Reports on Form 10-Q. Copies of Allergan’s press releases and additional information about Allergan are available at www.allergan.com or you can contact the Allergan Investor Relations Department by calling 1-714-246-4636.
©2014 Allergan, Inc. Irvine, CA 92612.® marks owned by Allergan, Inc. All rights reserved.
Myobloc® is a registered trademark of Solstice Neuroscience, Inc.
Dysport® is a registered trademark of Ipsen Biopharm, Ltd.
Xeomin® is a registered trademark of Merz Pharma Gmbh & Co.
1EyeCare America (A program of the Foundation of the American Academy of Ophthalmology); “Strabismus.” Available at: www.eyecareamerica.org/eyecare/conditions/strabismus/index.cfm.
2Simon, G. Benign Essential Blepharospasm. Int Ophthamol Clinical 2005; 45: 49-75.
3Allergan data on file
4Allergan data on file; Global Safety and Epidemiology
5Allergan data on file; Global Medical Affairs
6Allergan data on file; Global Literature & Information Services and Global Regulatory Affairs