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If you watch the latest episode of “The Technology of Beauty” on YouTube with Grant Stevens. His guest, David Pyott, their discussion covers the 1.6 to 1.8 retention of a Botox patient…
plus Pyott feels 6 months of toxin duration is the magic spot which will become the industry gold standard.
Toxin Competitors Focus on Doubling Dosing
The neurotoxin market segment is undergoing a long overdue renaissance with the recent FDA approval and commercial release of DAXXIFY (Revance Therapeutics Inc., Nashville, Tenn.), the new longer duration wrinkle relaxer. DAXXIFY’s appearance has prompted other cosmetic neurotoxin manufacturers to investigate higher doses in order to boost the duration of treatment effect.
Traditionally, the FDA limited the amount of neurotoxin used on the face to 12 to 24 units, depending on the area of injection, but DAXXIFY showed that twice that dosage — 40 units — could last as long as six months, and with faster onset. To compete, manufacturers are rapidly designing new neurotoxins, or reformulating existing products that last longer. Many of the newest clinical studies from Merz Aesthetics, Galderma, Allergan Aesthetics, and Evolus focus on increased dosage as the answer to extending duration of effect. “I think we can all agree on one thing: increasing the dose of a neurotoxin regimen can increase duration,” expressed Joely Kaufman-Janette, M.D., a dermatologist in Coral Gables, Fla., who worked on some of those longer-duration neurotoxin studies.
“It’s been a race to the finish line for these companies, as DAXXIFY hits the streets,” said Michael H. Gold, M.D., FAAD, a dermatologist and one of the clinical researchers of Merz Aesthetics’ upcoming longer duration neurotoxin. “There’s no question that higher doses last longer. Allergan is going from 20, 40, 60 to 80 units. Galderma is doing 50, 75, 100, even as high as 125 units. For Xeomin, it’s 100 units. Evolus just put together its first preliminary data for their high dose toxin. The results are significant, but the interesting thing is that they only studied 20 and 40 units.”
The effort by manufacturers to double and triple dose is nothing new. For example, Allergen Aesthetics in 2018 announced clinical study results evaluating the duration of effect and safety of BOTOX Cosmetic in 40-, 60-, and 80-unit doses versus a 20-unit dose in patients with moderate to severe glabellar lines. The results showed the study met the primary efficacy endpoint, and that it was statistically significant.
According to an industry expert close to the matter who must remain anonymous, “There may be some pitfalls involved with these companies trying to just double up on dosages, thinking that is going to improve the efficacy and the duration. Isn’t there a law of diminishing returns in doing that? At what point does increasing the dosage not accomplish what they set out to do? If the effect is not as strong, or not as predictable as they’d like, then does it end up being more of a marketing ploy than anything scientific?”
DAXXIFY is unique in other ways. Revance formulated it with a 35-amino acid peptide excipient (RTP004) that prevents surface adsorption and promotes thermal stability. The company promotes this novel peptide benefit in marketing literature and podium talks by highly paid physician KOLs. It much more loudly promotes the novel dosage comparisons between DAXXIFY and traditional neurotoxins, which sometimes sound like apples and oranges. For example, a prominent clinical trial result compared 20 units of BOTOX Cosmetic and 40 units of DAXXIFY in measuring duration of effect. On the surface, that comparison may have sounded weak, but it was good enough for the FDA. Evolus’ seemingly more apples-to-apples comparison placed 40 units of its Jeuveau neurotoxin against 40 units of DAXXIFY.
According to Sue Ellen Cox, M.D., FAAD, a cosmetic dermatologist and researcher in Chapel Hill, N.C., “Increasing both duration and efficacy is not a straightforward topic. Lots of things make it difficult to compare the results across brands. Each company uses its own assays, which are proprietary, to measure strength and nanograms of protein. Some studies also look at a one grade versus two grade improvement.”
As reported by Rui Avelar, M.D., Head of Research and Development and Chief Medical Officer at Evolus, Inc. (Newport Beach, Calif.), “As you increase the dose you can increase efficacy and duration, but there comes a point where increasing the dose doesn’t show an improvement. During the BOTOX tests, what Allergan found was when they doubled the dose, they saw a bit of hyper-concentration, as well. And they used half the diluent. They showed that when you looked at a one-point improvement, the duration was about 24.1 weeks, and when they went with a higher dose, they really didn’t see a benefit. From a corporate perspective, this becomes a key issue in terms of how to price the higher dosage. When you look at the DAXXIFY data, they did 20 units, then 40 units, and then 60 and I believe they also did 80. At 20 units it showed efficacy, and 40 also showed efficacy.”
Revance published their Phase 2 Belmont study1 in 2017, which compared 20 units of DAXXIFY versus 20 units of BOTOX. “Across 24 weeks, there was no difference between the two,” noted Dr. Avelar. “If there is a peptide effect, then it doesn’t show. I know Revance talks about its peptide, but the FDA label clearly states the peptide has no activity.”
The issue for all these companies is how much to increase the dosage and how much longer a treatment will last. “There seems to be a plateau, and we see diminishing returns when we get to a certain dose,” said Dr. Kaufman-Janette. “The studies show that increasing the dose just plain old increases longevity. The point of a final plateau is different for each toxin and most likely also varies by patient. Also, some patients show very short duration of effect with a moderate dose, while others will get a very long duration with the same dose.”
Dr. Gold agreed, in part. “The Merz and Galderma studies were impressive as far as high doses and longevity,” he said. “Evolus only went up to 40 units. They did it to compete with Revance, because the reality of DAXXIFY is that it has an FDA approval for lasting six months, which is the new standard. Of course, we have yet to see if that duration is going to be consistent in the real world. If it does, great. If it doesn’t, then we will learn why quickly. There’s no question that if you dilute differently, put in more concentration and a higher dose of toxin, then you’ll get a longer lasting result. That’s the trend. I’m not sure if the other companies are going to go for labels, or if they just want to publish to show people that they have the longer effect. Each company will make that decision.”
As other manufacturers come into play, Revance will not be the only company offering a six-month neurotoxin, noted Gregory A. Buford, M.D., F.A.C.S., a plastic surgeon in Denver, Colo. “DAXXIFY will level the playing field. Competition is always good. When Allergan was the only show in town, it did not have to compete with anybody. There was nothing forcing them to be better, except themselves. The field is growing more competitive, and the technology is speeding up. Take Galderma, for instance. It’s developing a liquid toxin for the U.S. marketplace that reportedly works within 24 hours and could have over a six-month effect of duration. That product could change the toxin landscape as much as DAXXIFY will.”
With the encroachment of longer duration neurotoxins, it may or may not make sense for physicians to offer higher doses. “What is the cost, both to the patient and to the physician?” asked Dr. Kaufman-Janette. “Does it make financial sense to dose this way? This seems to be the big market consideration.”
According to an industry insider, “The market dynamics will get quite interesting. We hear some talk about how the typical patient will end up coming in twice a year, wanting a long-duration toxin. But that is not necessarily what HCPs want. They want patients to come back more often, not only for toxin but also other types of treatments. The trend is that a percentage of the patient population seeks long-duration products of all kinds, from neurotoxins to fillers to fat reduction. So, physicians just want the option of having a longer duration toxin because some of their customers will ask for it.”
These products must still prove themselves in the marketplace, said Dr. Cox. “From a physician’s practical point of view, it comes down to price. Some of the clinical studies out there talked about using up to five times an on-label dose, which would be prohibitively expensive, just in order to potentially get an extra month or two of duration. Also, no one’s really done head-to-head studies. The companies do clinical studies in a structured, regimented way so they can get FDA approvals. They find the top injectors and hand pick a certain patient demographic. Those are not the essential studies. The more important ones are going to be in the hands of practitioners and play out in a real-world setting, meaning in their practices and on their patients. These are just a few of the confounding issues.”
Dr. Gold echoed these sentiments. “Anyone who says they know the true duration of DAXXIFY or any future longer lasting toxin is full of it. We are already aware of the outcome. If you use the product the way you’re supposed to use it, it is going to be more expensive than the traditional 20-unit treatment. If it’s more expensive, then it’s going to offer some benefit in terms of duration. But we don’t really know how this will go. It’s going to take at least a year for us to know duration, efficacy, and patient support.”
With DAXXIFY barely out in the field, and other manufacturers looking at months, even years before their products launch, “It’s impossible to know how or if the market will accept this new neurotoxin world order,” said Dr. Buford. “The studies mean very little to me because that’s not real life. That is ‘study land.’ You can get numbers to say pretty much whatever you want to say within reason. You can stretch results, compare and create different spins, but, ultimately, what is the true duration of effect? What plays into that? And what price do you pay for that duration? Not necessarily the financial price, but the price of a heavier brow and over-treated jaw. Results may last for six months or more, whether we like them or not. Even the best injectors in the world don’t hit home runs all the time. We have our days when we are like, yeah, I might’ve dropped her brow. It happens infrequently, but when it happens, I tell patients the bad thing about BOTOX is that it wears off, and the good thing about BOTOX is that it wears off.”
The industry insider noted something about DAXXIFY that could have repercussions in the marketplace. “The narrative is that there’s a new 40-unit toxin with six months duration on label,” he said. “I’m sure you’ve heard that, but it doesn’t exist. Pick up the label and look for a duration claim. There is none. Keep in mind, what Revance is doing is very positive because they are trying to expand the market. We can help contribute to that market so that we all win. But when they talk about duration and say they have a median of 24 weeks, which, they say, quote-unquote, is six months, that’s not right. Twenty-four weeks is not six months, it’s more like five-plus months. They could set unrealistic expectations for people for the sake of marketing. I hope that doesn’t destroy this entire sector, because there is a scenario where over-promising can actually taint this effort at estabishing longer duration as the gold standard.”
The average Botox patient is treated 1.8 times a year. Any practice saying their patients return every 3 months should do a retention analysis and discover the truth.
Scheduling patients to return for both their toxin and filler at the same appointment is $$$..you are talking $3,000 plus for 1 hour of patient time. Doing this 8 hours a day is $24,000 per day. Average doctor works 1600 hours a year. 1600 hrs times $3,000 = $4.8 million…huge practice financial advantage scheduling patients to get toxin and filler at same appointment 2 times a year!!!!
Another interesting point on the call today was full Daxi commercial launch at the end of Q1. But RVNC only trained in Q1 approximately, the same number of practices as in PreView ( 400 ) and many of these practices have multiple injectors…the injectors not trained in Nashville, are trained remotely and can inject the immediately. So currently Daxi is available at 800 practices out of 40,000 in the USA…6 months after approval???
Another interesting point was when Tobin referenced additional Daxi manufacturing coming soon as the true window to maximizing sales…
IMHO—-my gut tells me the slow Daxi rollout has to do with limited Daxi manufacturing and RVNC does not want to create too much Daxi demand and go into Daxi back order! That would be a huge problem! My guess is Q1 Daxi sales will be 15 to 18 million. Will RVNC continue to train 400 practices every month or will they wait a month or 2 and stockpile Daxi product?
The rumor is Daxi sales in Q1 were “Big”…we will soon find out if the rumor is accurate.
Notice Piper Sandler is the biggest fan!
Inspire Investing LLC Increases Stake in Revance Therapeutics by 66.4%: Market Analysts Recommend Buy Rating for RVNC Stock
Roberto Liccardo by Roberto Liccardo April 12, 2023
RVNC stock news SHARES
In recent news, Inspire Investing LLC has increased their stake in Revance Therapeutics, Inc. by a staggering 66.4%. Based on the company’s recent Form 13F filing with the Securities and Exchange Commission, Inspire Investing LLC now owns 12,798 shares of RVNC, worth $236,000 by the end of the fourth quarter of last year.
Revance Therapeutics is a clinical stage biotechnology corporation that focuses on creating novel botulinum toxin products for aesthetic and therapeutic purposes. With its cutting edge product daxibotulinumtoxinA, RVNC aims to develop solutions for patients suffering from various muscle-related disorders and facial wrinkles.
Following numerous research analyst reports suggesting that purchasing shares of this innovative firm may be an excellent investment opportunity; several market analysts have recommended “buy” ratings for RVNC stock. StockNews.com upgraded their assessment from a “sell” to a “hold,” while HC Wainwright issued a “buy” rating for RVNC stock with a price target set at $42.00 per share. Barclays also recommended an upgrade in stock overvaluation from $37.00 to $40.00 with Mizuho increasing their target price from $30.00 to $33.00.
Finally, Piper Sandler went as far as giving the company an entire overhaul by promoting from the overweight category to buy ratings and raising its previously assigned price goal standing at $29 per share up to an impressive value set at around $40 per share.
IMHO---there are patients who are being injected with Daxi and are NOT being given double the active ingredient in ALL or some of the injection areas and injectors are charging a big premium. Cosmetic Practices are in business to make money too and there is NO WAY for a patient to know if they ACTUALLY received double the dose....Cosmetic dosing and hyper diluting has always been an issue. There are a lot of cosmetic practices that hyper dilute to make greater profit....And there are also many practices that dose correctly....so over time this cosmetic dosing issue will correct it's self as patients learn which practices are injecting (2 to1) and charging (70% of other toxin per unit) correctly!
Therapeutic CD will be the correct dose of 2 for 1...so these patients will see the full 6 month duration.
Might be a good idea for Revance to address this dosing issue so patients understand that the 6 month duration happens only when the injector uses the 2 for 1 recommended dose.
First Take
Revance Therapeutics, Inc. (RVNC)
April 11, 2023
Price: $31.47; Market Cap (M): $2,606; 4/10/2023 Close
Rating: Buy; Price Target: $42.00
Douglas Tsao - (212-916-3968) / dtsao@hcwresearch.com
Takeaways From Our Conversation With Revance Therapeutics' President; Reit Buy
During the second call of our series, Dustin Sjuts, President of Revance, provided further details on PreVu, the
early experience program for Daxxify that saw strong uptake for the neuromodulator and generated $11.0M in sales
during December 2022. Moreover, we discussed the company's strategy for a potential launch for Daxxify in cervical
dystonia. A replay of the call can be found be clicking HERE.
Added color to Daxxify’s early experience program as broader launch gets started. Immediately after receiving
FDA approval, Revance initiated the early experience program—dubbed Prelude by the company—by giving access
to Daxxify to a very limited number of 20 injectors who would then serve as faculty for the approximately 400
accounts included in PreVu. Sjuts indicated to us that the accounts included in PreVu were selected by Revance’s
sales force based on different criteria such as being early adopters of the RHA line and their willingness to treat
patients with Daxxify, to create experiential data on using Daxxify and maximize the value of PreVu for the broader
launch. There was no requirement on the minimum amount of product to be used during PreVu though clearly
PreVu participants were incentivized to maximize their early access. Moreover, participation in PreVu gave them
an exclusive opportunity to buy Daxxify and pre-schedule injection appointments during the holidays, which is the
busiest time of the year for consumer activation in aesthetics. This translated into the significant utilization and
impressive revenue seen in December, well above Street expectations. For the early stages of the launch, the
company has focused on driving depth of adoption within accounts over breadth, noting that "dabblers" can be time-
consuming for the sales force but drive a low ROI.
Obviously Daxxify's value proposition hinges on its duration profile. While it's still too early to get a read on duration
from patients in PreVu, Sjuts noted that there has been some longer experience from patients that received Daxxify
during "Prelude," the early access period for clinicians that would serve as faculty for PreVu (roughly 20 clinicians).
Sjuts noted that early feedback suggests that Daxxify duration has been consistent with the clinical trials and he
made a point of noting some patients in Prelude needed re-treatment at three to four months while others are seeing
duration past six months. Recall, there was a range in the Daxxify’s clinical trials with duration as short as just three
to four months, but also beyond nine months, with the median standing at roughly six months. It is going to be
interesting to us how consumers react that variability, though we think providers are helping frame expectations for
consumers realistically. We should gain more clarity on how often patients are going in for a subsequent injection
by 2H23, as patients who got injected during PreVu reach the six-month mark in the next few months.
Sjuts noted that Early feedback from PreVu has been positive and results have been consistent with those observed
in clinical trials. However, unlike clinical trials, where injections with Daxxify were limited to the glabellar lines, in
PreVu Daxxify has been used in different areas including forehead, around the eyes (crow’s feet), masseter muscles
and neck. While we were a bit surprised by how quickly some injectors expanded their use of Daxxify beyond the
glabellar lines, management said they expected injectors to test the “limits” of a new product. That’s particularly
true because patients generally want to be treated in multiple areas of the face and so Daxxify’s value proposition
would be limited if its use didn’t go beyond glabellar lines. The company remains confident in its ability to continue
to drive success of the brand with the clinical data that they currently have, so they don't plan seeking additional
indications, such as crow's feet. While adding new indications would allow sales reps to promote those indications
and provide direct training, Sjuts noted that it can be limiting as well since repos would be limited to training based
on the protocols/techniques used in the company-sponsored trials. In their view, physicians prefer to develop their
own methods even if they learn from other clinicians. Based on the broad use during PreVu, it does not seem like
it is needed.
For definitions and the distribution of analyst ratings, analyst certifications, and other disclosures, please refer to pages 3 - 5 of this report.
Our channel checks point to Daxxify’s fast onset of action and that it looks more “natural look at rest” than
other toxins as other differentiating characteristics. Sjuts also noted feedback that Daxxify doesn’t cause the
same feeling of “heaviness” that often occurs with other neurotoxins as well as hearing about a faster onset of
action. He also noted that they’re achieving these results with the same volume of neurotoxin, which clearly
seems intended to address Evolus’ work with an “extra strength” formulation. As competitors show longer
durability of effect for their neuromodulators, Revance remains confident its differentiated formulation will
be a competitive advantage as clinicians don’t like injecting double doses of neurotoxin to extend duration
as it affects the overall look and the safety profile.
Revance’s broader launch strategy, just like PreVu, is focused on providing accounts with product
experience to result in practice integration for Daxxify and extend adoption duration. With that goal, the
company is planning on offering both in person and virtual training events. The next phase of the launch
will include the approximately 5,000 aesthetic accounts that are already purchasing the RHA filler line.
Beyond those, Revance is targeting the 12,000-15,000 “prestige” accounts that do not advertise price, which
represent half of the market for Daxxify. The RHA filler line has done considerably better than we expected,
and we’re sanguine that Daxxify’s approval should unlock additional market share. Management noted that
the availability of Daxxify during PreVu led to some accounts “leaning into” the RHA line more than they had.
Management noted that in the early going that pricing has varied. Sjuts noted their market research has
indicated consumers would be willing to pay roughly 1.5x for a product that offered longer duration. In
the early going with PreVu, there’s been wider variance with some practices charging up to 2x as much
though others offering the first treatment with Daxxify at parity with other neuromodulators but subsequent
treatments at a premium. Management reiterated the importance of their policy of not allowing injectors to
advertise pricing. This prevents practices from trying to use price as a lever to attract patients and eroding
pricing. While there’s been a widespread in the early going, management expects the pricing band to narrow
over time.
Revance’s launch strategy in therapeutics will mirror the one in aesthetics. With the PDUFA target
action date for Daxxify in cervical dystonia (CD) set for August 19, 2023, commercial plans for the launch
in the company’s first therapeutic indication are ongoing. As done in aesthetics, Revance is planning a
PreVu phase to get real world data on how physicians will use Daxxify for the treatment of CD in terms of
dosing and treatment interval. While payers typically only allow re-treatment every 12 weeks, many patients
experience loss of symptom relief before their next injection, with mean time to symptom recurrence ranging
from 9.3 weeks to 12.8 weeks. Daxxify’s extended median duration of effect of 24 weeks for the 125 U group,
offers the possibility for patients to reach the 12-week retreat point with less symptoms and still opt for a re-
treatment or wait until symptoms reappear to get retreated. Thus, information from PreVu will also help the
company shape its strategy with payers to secure market access, where we think Daxxify can provide an
economic benefit by reducing the frequency of treatments. Beyond the extended effect duration, Daxxify’s
value proposition resides on the results achieved with a lower volume of toxin compared to competitors that
resulted in a more favorable safety profile. Recall, Daxxify-treated patients showed significantly lower rates
of dysphagia, a common side effect of toxin treatment in CD. Dependent on FDA-approval, Revance’s goal
is to conduct the PreVu phase during the second half of this year and enter the market in early 2024.
Valuation and Risks. Our Buy rating and price target of $42 for Revance are based on our sum-of-the-
parts NPV valuation of each of Daxi’s targeted indications as well as Teoxane and HintMD. Our DCF model
utilizes a derived discount rate of 9.5% (Beta of 1.0, market premium of 6.0%, and risk-free rate of return
of 3.5%). We adjust each indication for probability of success, most notably with glabellar lines at 100%
with approval, cervical dystonia at 85%, ULS at 85%, chronic migraine at 40%, and the Botox biosimilar
at 60%. Risks include regulatory, as Daxi is not FDA-approved for all indications the company is pursuing,
commercial adoption, new products launched by competitors, clinical trial execution in various therapeutic
indications, and the effects from COVID-19.
Revance Therapeutics, Inc. April 11, 2023
H.C. WAINWRIGHT & CO. EQUITY RESEARCH 2
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Very little after hours trading of RVNC..seems like someone (s) is manipulating the price.
RVNC should get CD approval in 4 months or sooner.
Allergan Aesthetic has made several upper management changes in the last 2 months since sales of all their aesthetics products are negative or significantly below their quarterly goals. Allergan is doing everything possible to blunt the sales of Daxi, except lower the price of Botox which they will never do since that would cost them millions on the Therapeutic reimbursement price. Botox is the cash cow for cosmetic and obviously therapeutic!! 2023 is the first year in maybe 15 yrs that the price for cosmetic Botox was not raised by 3 to 5%..raising the cosmetic price, directly raises the Therapeutic price…so now their revenue grow is 100% with units sold versus a price increase…another challenge!!! The other Allergan aesthetics products are being used to protect Botox revenue.
HUGE Cosmetic digital marketing campaign for Botox is happening now with the hiring of over 100 digital employees by the Allergan Data Labs…everything is now in house!
On my Instagram, I have been getting several posts from Third Party sites with the tag line - “Botox is affordable”..:it appears Allergan has hired third party digital marketing companies to use this tag line and drive patient to Allergan’s various websites.
Allergan only mentions price and does not discuss duration…hence, the patient buys Botox but the value is below Daxxify because of the short duration. And Allergan continues to charge doctors a high purchase price for Botox. Doctors makes less and less profit with Botox.
A few aesthetic offices which I am familiar with offer FREE staff toxin injections…every office uses Dysport on the staff because it lasts longer than Botox…curious to see if these offices switch to Daxxify. Everyone (physician and all injectors) knows Botox only lasts 2 to 3 months…patients are loving the quick onset and long duration of Daxi.
This week is the beginning of the 2nd round of Daxi Injector trainings. For the next 2 to 4 weeks 1000 to 1250 injectors will be trained each week, which then allows the injectors to order Daxi….should provide nice Daxi sales numbers for Q1 and Q2..as well as repeat orders from the 400 injectors trained in Q4. As you can see, RVNC is spreading the training/orders between Q1 and Q2 to give great quarter numbers and quarter over quarter growth!!!
SEVEN REASONS WHY THE MEDICAL AESTHETIC MARKET IS INFLATION AND RECESSION RESILIENT
AUGUST 16, 2022
BRAEDEN LICHTI
Shutterstock
There is no such thing as recession insurance, but as one of my most brilliant mentors used to preach, “You can dig your heels into the dirt of a constantly changing market and die, or learn to be flexible.” While most market predictions are speculation, the most reliable, and safe, place of wisdom can come from reviewing history. This article will review the historical trends and current market performance of medical aesthetics, and why this points to resilient investing.
History repeats itself.
1. The Lipstick Effect. During times of war and economic uncertainty, people will indulge in pleasurable expenses to offset stress and meet emotional needs, according to sociologist Juliet Schor. As the saying goes, give a woman the right lipstick and she can conquer the world.
According to NPD Group, lipstick sales doubled by 48% in the first quarter of 2022 compared to the previous year. During the recession of 2001 and 2008, Chanel and Estée Lauder celebrated an 11% increase in lipstick sales, according to a study published in the The Economist. Even medical spas have consistently grown by 15% since the beginning of the COVID-19 pandemic.
2. Job Market Competition. As a consequence of the pandemic, millions either lost their job, changed jobs, or shifted careers entirely. Consumers are looking to improve their looks when trying to gain or keep employment during times of economic recession, especially those in their 40s and 50s as they compete to make themselves more viable candidates, according to Cindy Graff Consulting LLC.
The pandemic forced the world focus to social media, and allowed many consumers to save cash for procedures and makeup that they have wanted for years. According to market research firm ReportLinker, the global medical spa market was estimated at $12.2 billion in 2020, and is projected to reach $25.9 billion by 2026.
A survey that collected data from 2,000 Americans found that Zoom calls heavily impacted how consumers view beauty and skincare, with 90% expecting to continue video calling even after the pandemic abates. This will be an impetus for more advanced treatments, including gene therapy and dermatologic surgery.
3. More Physicians Are Entering Aesthetic Medicine. According to data from 2001 to 2007 by the American Society for Dermatologic Surgery (ASDS), researchers found that surgeons performed 3.4 million cosmetic and non-cosmetic surgical procedures in 2001. This jumped to 7.6 million by 2007, with the numbers continuing to climb. Since 2000, the medical community has vigorously promoted preventative care, which has highlighted the emphasis on anti-aging.
Due to the rising overhead costs of running medical practices, more physicians than ever are getting certified to perform medical aesthetic treatments. OB-GYNs, emergency medicine, neurologists, and even orthopedic surgeons are capitalizing on the natural bridge of an existing practice to add more revenue streams. Anti-aging issues frequently come up during physician appointments, which allow healthcare providers to cross-sell cosmetic services. Physicians are trained to keep up with medical technology, and medical aesthetics is more than lucrative.
4. The Rise of Beauty Influencers and Online Marketing. According to Google, 66% of beauty product buyers say YouTube influenced their purchases by helping them visualize how products fit into their lives. In addition to brand-published videos, YouTube tutorials from popular influencers help spread awareness and exposure. Savvy brands are riding this digital wave by publishing original content, blogs, and media to increase their brand’s message and help with search engine optimization. Not only does this gain readership, it creates a more engaged community for medical aesthetics.
5. The Distinction Between Prestige, Mass, Masstige, and Value Has Blurred Over The Years. Consumers are willing and funded to spend on high-quality, high-tier anti-aging treatments such as surgery, gene therapy, and invasive procedures. In times of recession, consumers typically trade down for lower-tier products when they feel they can buy a similar product at a cheaper price point. However, during this recession, the market has not experienced this downshift in regard to medical aesthetics. Consumers see the safety, credibility, and value in these treatments, which switches the idea of “would like to have,” to “I need.” Most beauty services also have built-in renewal, which has helped medical aesthetics stay recession proof.
6. Medical Aesthetics Treats Pathology. Taking novel approaches to stem cell exosome innovations as an example, not only does this technology has the potential to reverse the signs of aging, but appears to dramatically reduce inflammatory pathologies like chronic redness and hyperpigmentation issues, according to recent clinical validation results. Studies show that this budding technology can also treat diabetic foot ulcers, wounds, and atopic dermatitis, to name a few.
7. Medical Aesthetics Is a Secular Growth Industry. Growth is driven by underlying technological and demographic trends rather than business-cycle fluctuations. Healthcare industries, in general, hold up well during recessions, as the demand for medical treatments will only increase with the aging population.
As investors evaluate business sectors in the next town, or crosswise over continents, the consistent and unprecedented growth of the medical aesthetics market looks to stand the test of time and has the numbers to prove it. The medical aesthetics market is expected to reach $29.43 billion by 2029, at a CAGR of 10.4% from 2022 to 2029. Data from over 150 mergers and acquisitions between 2015 to 2019 showed that skincare industry transactions had an average revenue multiple of 3.6x and an average EBITDA multiple of 15.3x, according to Rare Beauty Brands’ report State of the Industry July 2019. Recently, more companies are merging to accelerate scaling the next generation of conscious, purpose-driven, research-backed brands.
Value-driven medical aesthetics options will do much more than smooth fine lines and wrinkles; they have the potential to offer more effective and long-term recovery options than traditional medically dispensed technologies. Healthcare providers see the benefit and lucrative potential in medical aesthetics, with more specialties than ever rushing to invest, get certified, and offer these aesthetic treatments in the clinic.
Despite inflation being at a 40-year high, medical aesthetics has been, and will continue to be, a resilient and reliable investment.
Hi Dew,
"Full Commercial Launch is Q2"--- April, May and June....March is still Q1...per discussions, Revance was planning to train 3000+ practices who purchased a specific amount of RHA before December 31, 2022 in March 2023.....these practices were promised to be trained in March 2023 and the Full Commercial Launch with direct to patient marketing in June 2023....
Now the full commercial launch is March, Q1...this tells me that Revance wants to sell more Daxi product faster!!!!
Thank you for the clarification!
TY Dew
June 2023 was previously determined as the commercial launch and start of their marketing as per the Q3 earnings conference call.
Dew,
Any thoughts on the guidance that “the full commercial launch of Daxi will be at the end of this month, March 2023.” Their previous guidance was the commercial launch would be June 2023.
Thank you!
Another thought...the latest RVNC would get FDA approval for CD is August 19, 2023...that is in 6 months....why have they not started to build the sales team????? Hoping for a very big announcement!
Would someone repost the doctor pricing for Daxi…I can not recall the tiers…
I know the 150 vials is $330…what are the smaller tiers?
Also, the 400 practices trained in December 2022 were the practices which used RHA…they were NOT the largest big practices…the largest big practices are being trained in March 2023…they will be ordering the 150 quality to get the lowest price and could do several orders a month! example..LaserAway!
On the November 2022 Stifel Healthcare Conference Call, Tobin, shared that RVNC would like to find a partner to work with them as they continue to market Daxi. My guess is that Foley and a financial team are 100% submerged in discussions with potential partners knowing each day that goes by costs RVNC $ for unapproved therapeutic applications which Daxi will quickly take market share.
With all the Hedge Funds and Institutional Funds buying up the RVNC stock, we are hoping there will be a very big announcement very soon! What do they know, that we don’t ??
This would give RVNC the resources to go after the 2.8 Billion therapeutic market and the 2 billion cosmetic market.
RVNC is training 3000 to 4000 practices the first 2 weeks of March 2023….in less than 2 weeks. Only a small group will be trained at Nashville…95% will be trained remotely. The average practice purchased $27,500 from the 400 trained in December and ordered in December. If this hold true again, 3500 times $27,500 = $96 million…plus repeat orders from the December 400. . RVNC might have their first $100 million Quarter Total Revenue ( Daxi plus RHA plus OPUL) ??????.
Galderma has all the Restylane Brand Filler Products. Galderma also provides Dysport which lasts about a month longer than Botox. Galderma has been gaining market share in both Toxins and Fillers over the last 2 years versus Allergan who has always done a good job advertising directly to patients....Now, patients are getting smarter.
Many doctors have been bullied by Allergan to purchase ALL Allergan products or pay higher prices for each individually and are switching to Galderma and Revance. Allergan will probably just leave their cosmetic toxin and filler products erode and make their money on Therapeutic Botox...ride the cash cow to the end...
Revance will quickly take the Therapeutic market with Daxi due to the 6 to 9 month duration. Short Duration is the #1 issue for Therapeutic patients.
Abbvie/Allergan continues to see sales of aesthetic products decrease as competitors take market share....Botox was only up 2.6 percent...there was a 4% price increase on January 2022....Botox sales actually were negative.
Daxi will take 50% market share quickly!!!
Galderma is now #1 Filler market share in USA!
Global net revenues from the aesthetics portfolio were $1.287 billion, a decrease of 8.5 percent on a
reported basis, or 4.2 percent on an operational basis.
? Global Botox Cosmetic net revenues were $642 million, an increase of 2.6 percent on a reported
basis, or 7.1 percent on an operational basis.
? Global Juvederm net revenues were $322 million, a decrease of 25.4 percent on a reported basis,
or 19.0 percent on an operational basis.
Per cutting the price of Botox
Allergan has been aggressively adding additional field sales and marketing directors and managers over the last 12 months either in an attempt to create a defense against Daxi or Abbvie is planning to buy Revance. It does not makes sense for Abbvie to be adding millions in payroll costs when both Juvederm and Botox are losing market share.
Abbive is not lowering the price for Cosmetic Botox…this would lower their government best price for Therapeutic Botox and cost them millions with average sales price…soon they will lose therapeutic market share. Not to mention off label therapeutic use once CD is approved…!
The issue with therapeutic Botox is it only lasts 2 to 2 1/2 months in repeat patients and the patients are in pain the last month. Hence, Daxi will totally take the therapeutic market…why get 30 plus needles 4 times a year when you and switch and only be infected 2 times a year with a Daxi which lasts 6 plus!
Abbvie needs to buy Revance if they want to continue as the KING of toxins ??
Great RVNC Reviews just keep coming....
What Makes Revance Therapeutics, Inc. (RVNC) a Strong Momentum Stock: Buy Now?
12:00 pm ET February 2, 2023 (Zacks) Print
Momentum investing revolves around the idea of following a stock's recent trend in either direction. In the 'long' context, investors will be essentially be "buying high, but hoping to sell even higher." With this methodology, taking advantage of trends in a stock's price is key; once a stock establishes a course, it is more than likely to continue moving that way. The goal is that once a stock heads down a fixed path, it will lead to timely and profitable trades.
Even though momentum is a popular stock characteristic, it can be tough to define. Debate surrounding which are the best and worst metrics to focus on is lengthy, but the Zacks Momentum Style Score, part of the Zacks Style Scores, helps address this issue for us.
Below, we take a look at Revance Therapeutics, Inc. (RVNC), a company that currently holds a Momentum Style Score of B. We also talk about price change and earnings estimate revisions, two of the main aspects of the Momentum Style Score.
It's also important to note that Style Scores work as a complement to the Zacks Rank, our stock rating system that has an impressive track record of outperformance. Revance Therapeutics, Inc. Currently has a Zacks Rank of #2 (Buy). Our research shows that stocks rated Zacks Rank #1 (Strong Buy) and #2 (Buy) and Style Scores of A or B outperform the market over the following one-month period.
You can see the current list of Zacks #1 Rank Stocks here >>>
Set to Beat the Market?
In order to see if RVNC is a promising momentum pick, let's examine some Momentum Style elements to see if this company holds up.
Looking at a stock's short-term price activity is a great way to gauge if it has momentum, since this can reflect both the current interest in a stock and if buyers or sellers have the upper hand at the moment. It's also helpful to compare a security to its industry; this can show investors the best companies in a particular area.
For RVNC, shares are up 4.51% over the past week while the Zacks Medical - Biomedical and Genetics industry is up 0.31% over the same time period. Shares are looking quite well from a longer time frame too, as the monthly price change of 81.14% compares favorably with the industry's 7.62% performance as well.
Considering longer term price metrics, like performance over the last three months or year, can be advantageous as well. Shares of Revance Therapeutics, Inc. Have increased 69.36% over the past quarter, and have gained 162.84% in the last year. In comparison, the S&P 500 has only moved 7.29% and -7.88%, respectively.
Investors should also take note of RVNC's average 20-day trading volume. Volume is a useful item in many ways, and the 20-day average establishes a good price-to-volume baseline; a rising stock with above average volume is generally a bullish sign, whereas a declining stock on above average volume is typically bearish. Right now, RVNC is averaging 2,299,012 shares for the last 20 days.
Earnings Outlook
The Zacks Momentum Style Score also takes into account trends in estimate revisions, in addition to price changes. Please note that estimate revision trends remain at the core of Zacks Rank as well. A nice path here can help show promise, and we have recently been seeing that with RVNC.
Over the past two months, 2 earnings estimates moved higher compared to none lower for the full year. These revisions helped boost RVNC's consensus estimate, increasing from -$4.38 to -$4.26 in the past 60 days. Looking at the next fiscal year, 3 estimates have moved upwards while there have been no downward revisions in the same time period.
Bottom Line
Taking into account all of these elements, it should come as no surprise that RVNC is a #2 (Buy) stock with a Momentum Score of B. If you've been searching for a fresh pick that's set to rise in the near-term, make sure to keep Revance Therapeutics, Inc. On your short list.
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Revance Therapeutics, Inc. (RVNC): Free Stock Analysis Report
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RVNC now #1
How Revance Therapeutics, The IBD 50's No. 1 Stock, Is Taking On 'Prestige' Medical Aesthetics
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ALLISON GATLIN01:39 PM ET 02/01/2023
Revance Therapeutics (RVNC) and RVNC stock are all smiles after the Food and Drug Administration approved the company's new treatment for frown lines.
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The injection called Daxxify is the newest botulinum toxin to hit doctor's offices in the U.S. Botulinum toxin drugs were first popularized by AbbVie's (ABBV) Botox in 2002. Revance gained FDA approval in September and generated roughly $11 million in fourth-quarter sales, the company said in early January.
Chief Executive Mark Foley says the barrier for medical aesthetics to enter the U.S. market is higher than in places like Korea and Europe where there are many competitors and knockoffs. Revance is going after "prestige" accounts — customers who want a high-end product. In addition to Daxxify, Revance also sells a series of facial fillers to smooth wrinkles, known as resilient hyaluronic acid fillers, or RHAs.
"I think the big question will be: Where does Daxxify ultimately settle out in market penetration?" he said during a recent health care conference. "And then, how much sort of lift does that give to the RHA line?"
The Daxxify approval has certainly given a lift to RVNC stock. Shares soared almost 37% in the two days after the FDA signed off on Daxxify. Revance stock pulled back through early January, but soared again — up 54% on Jan. 9 — after the company preannounced its fourth-quarter sales.
Now, shares have a best-possible Relative Strength Rating of 99, according to IBD Digital. This puts RVNC in the top 1% of all stocks in terms of 12-month performance.
RVNC Stock Investors Didn't Expect Much From Drug
Administered through injection, Daxxify is a neuromodulator, meaning it impacts the way the nerves work. In this case, it prevents a chemical called acetylcholine from releasing. Without this chemical, affected muscle won't tighten. This helps smoothen wrinkles.
Revance salesSerge Belanger, a Needham analyst, says RVNC stock investors didn't expect much from Daxxify in the fourth quarter.
"Little to no Daxxify sales were expected in the fourth quarter and yet the product generated $11 million in sales during the short time since the PrevU (early experience) program initiated, meaning that 2023 sales estimates will likely need to be revised upward," he said in a recent note to clients.
The PrevU program focuses on 400 doctors given early access to Daxxify before a full commercial launch planned for late in the first or early in the second quarter.
"Even management was surprised by strong Daxxify uptake coming off the PrevU program," Mizuho Securities analyst Uy Ear said in a note. "In our view, the strong fourth-quarter Daxxify performance should help de-risk the consensus sales forecast of $65 million to $70 million for Daxxify in 2023, which has been a source of significant investor concerns."
RVNC stock broke out of a cup-with-handle base, topping a buy point at 30.70 on Jan. 20, according to MarketSmith.com.
Launching During A Pandemic
Analysts covering RVNC stock expect the company to report $220.3 million in 2023 sales. On a year-over-year basis, sales would rocket almost 74% over forecasts for $126.9 million for 2022. The company also is expected to become profitable in 2025 with adjusted earnings of $1.65 a share.
In addition to Daxxify sales, Revance preannounced $34 million to $35 million in sales of its fillers. The so-called RHA products mimic the body's own hyaluronic acid, a chemical that helps smooth the skin. Revance's RHA products are also injectable drugs. The company also sells a payment management system called Opul.
Needham's Belanger noted the filler sales "significantly (outpaced) most Street estimates." He has a buy rating on RVNC stock and raised his price target to 38 from 35.
"The overall aesthetic market appears healthy ahead of the formal Daxxify commercial launch," he said.
Foley, Revance's CEO, says the company is very pleased with the performance of the filler line.
"We launched this product line in the middle of the pandemic without the benefit of our toxin, and we continue to believe that it's the best product line that's out there," he said.
Holding 8% Of Market
Revance estimates it currently has 8% of the global market in facial fillers. That compares with the roughly 10% owned by AbbVie's Juvederm filler in Europe. And with the approval of Daxxify, Foley says Revance has the opportunity to bundle its products to give doctors a better deal and patients a better experience.
"If you only have a single product, a single filler or single toxin, you lose some of the sales force leverage that you get when you have two products in the bag," he said.
And despite recessionary concerns and ongoing inflation, Revance isn't seeing any slowdown in spending on medical aesthetics. Neither is RVNC stock, which has a best-possible IBD Digital Relative Strength Rating of 99. This puts shares in the top 1% of all stocks in terms of 12-month performance.
"We're targeting the prestige segment or the higher end of the accounts, which naturally attracts higher-end consumers, because they have choice and they've elected to go to a plastic surgeon or a dermatologist or a high-end med spa office, which typically is not the cheapest," Foley said. "So, we think that consumer is going to be less impacted."
Recurring Revenue For RVNC Stock
Another key point: Medical aesthetic treatments often mean recurring revenue that's paid out of pocket.
But through 2026, analysts following RVNC stock expect sales to decelerate. Part of the key to slowing or staving off the deceleration will be adding new approvals for Daxxify. AbbVie's Botox, for example, is also used to treat other conditions like migraine prevention and excessive sweating.
In August, the FDA will consider Daxxify for patients with cervical dystonia, a painful condition in which the neck muscles contract involuntarily. Revance is also studying Daxxify in patients with plantar fasciitis and upper limb spasticity. The latter is a condition that causes the muscles of the arms and hands to become tense and overactive.
The market for Daxxify as a therapeutic is more concentrated, CEO Foley said. He estimates 80% of the volume in cervical dystonia treatment will be from fewer than 1,000 doctor's offices.
"So we can be much more targeted," he said.
RVNC stock is also prestige in another way — it ranks first on the IBD 50 list of elite growth stocks.
Follow Allison Gatlin on Twitter at @IBD_AGatlin.
below is the link
https://investorplace.com/2023/01/3-pharma-stocks-that-will-mint-millionaires/
Revance (RVNC)
Close-up portrait of her she nice-looking attractive lovely charming feminine confident straight-haired girl touching face collagen botox nourishing isolated over gray pastel color background. RVNC stock
Source: Roman Samborskyi / Shutterstock.com
In September, the FDA approved Revance’s (NASDAQ:RVNC) anti-frown line injection, DAXXIFY.
Like Botox, the product is a neutrotoxin. However, DAXXIFY’s effects last about six months, while Botox’s impact only lasts for roughly 13 weeks or slightly over three months, This gives DAXXIFY a huge advantage.
Revance CEO Mark Foley reported on the company’s third-quarter earnings conference that there have been more than 1.1 billion hits on online articles regarding DAXXIFY in the roughly two since the treatment had been approved.
On Jan. 10, Revance reported preliminary fourth-quarter revenue of $10.5 million to $11.5 million from DAXXIFY. That’s a solid start, but of course it barely scratches the surface of the injection’s potential.
Likewise, the $2.73 billion market capitalization of RVNC stock is quite low and can easily soar 20 times if DAXXIFY become a blockbuster.
No...same as the publication...
3 Pharma Stocks That Will Mint Millionaires
These three pharma stocks could easily become huge winners
1d ago · By Larry Ramer, InvestorPlace Contributor
These pharma stocks all have excellent risk-reward ratios and could easily become blockbusters.
Revance (RVNC): The company’s anti-frown line injection lasts much longer than Botox.
Shockwave Medical (SWAV): The adoption of SWAV’s innovative treatment for cardiovascular cancer is growing rapidly.
Immunocore (IMCR): Scientists have validated IMCR’s anti-cancer technology and it could eventually treat many cancers.
Piper Sandler Maintains Overweight on Revance Therapeutics, Raises Price Target to $40
6:24 am ET January 31, 2023 (Benzinga) Print
Piper Sandler analyst David Amsellem maintains Revance Therapeutics (NASDAQ:RVNC) with a Overweight and raises the price target from $29 to $40.
If you recall, one of the videos shared a Doctor referencing that he was playing with the unit dose volume of Daxi in various areas of the face. In the stronger muscles, he would use 2 units of Daxi, in weaker muscles he was using 1.5 units of Daxi (compared to Botox). ..(1 Unit Botox versus 2.0 units of Daxi)…the point is injectors can ask the patient how long they want the duration to last, and the injectors can provide the appropriate Daxi. No other toxin can do this!!!
The Belmont study demonstrates that 20 units of Daxi will last 4 months…which is long than 20 units of Botox…
Daxi will become a true art form for each injector…they will have their Daxi unit formulas for each muscle area of the face! No other toxin will be needed!
https://www.businesswire.com/news/home/20170615005381/en/Positive-BELMONT-Phase-2-Trial-Results-Published-in-Dermatologic-Surgery
Dew,
What are your thoughts?
Extra-Strength" Formulation of Jeuveau® Demonstrates Effects Lasting 26 Weeks in Interim Phase II Data Results, Representing Prolonged 6-Month Performance
01/28/2023
Download(opens in new window)
“Extra-strength” 40U formulation achieves one-point improvement on the Glabellar Lines Scale with the duration of effect lasting 26 weeks, representing a prolonged 6-month performance
Results indicate a favorable safety profile; no serious adverse events reported and 88% of all adverse events were mild
Potential new “extra-strength” formulation would expand Evolus' Jeuveau® offering
Trial completion expected mid-2023; final results anticipated to be presented in 2H 2023
NEWPORT BEACH, Calif.--(BUSINESS WIRE)-- Evolus, Inc. (NASDAQ: EOLS), a performance beauty company with a customer-centric approach focused on delivering breakthrough products, today presented interim data from its Phase II clinical study evaluating an "extra-strength" formulation for extended duration of Jeuveau® (prabotulinumtoxinA-xvfs), its flagship neurotoxin product, at the 2023 International Master Course on Aging Science (IMCAS) World Congress in Paris. The data indicated that the “extra-strength” formulation of Jeuveau® at 40U (units) achieved a duration profile of 6 months or 26 weeks.
The extra-strength glabellar line study is a multicenter, double-blind, randomized Phase 2 trial following 150 patients for up to 12 months or until the patient loses their correction. The study has three arms: Jeuveau® Extra-Strength 40U and two active controls, Botox® 20U and Jeuveau® 20U. An interim analysis was performed to assess the safety and efficacy of the extra-strength formulation. At this time, Jeuveau® Extra-Strength has demonstrated 6 months (26 weeks) duration across the three metrics presented, including the time it takes for patients to return to their baseline Glabellar Line Scale (GLS) score after their treatment, time back to baseline for patients with a response of none or mild on the GLS, and the duration of effect of at least a one-point GLS improvement. The adverse events profile across all three arms was similar. The severity rating demonstrated that 88% of the events were mild and 12% were moderate. Importantly, no serious adverse events were reported.
“The interim results of this study are a significant step forward in our strategy to provide a longer-duration treatment option to patients, and we are very pleased that the ‘extra-strength’ formulation of Jeuveau® demonstrated a duration of 6 months or 26 weeks,” said Rui Avelar, M.D., Chief Medical Officer and Head of Research and Development, Evolus. “These data are very encouraging from a safety and efficacy perspective as we are seeing improvement on the GLS scale together with a favorable safety profile.”
“The combination of results from the ‘original strength’ trials and this exciting new ‘extra-strength’ data further reinforces Jeuveau’s® efficacy, offering greater flexibility for clinicians and patients while maintaining a similar safety profile between the two formulations,” said David Moatazedi, President and Chief Executive Officer, Evolus. “‘Extra-strength’ Jeuveau® can be formulated using the same vial used for the ‘original strength’ Jeuveau® simply by modifying the reconstitution. This provides the runway for an exciting option for our customers that already value Jeuveau’s® unique precision profile while delivering natural-looking results.”
Jeuveau® is approved for the temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at maximum frown (glabellar lines) in adults below 65 years of age. The safety and efficacy of Jeuveau® was evaluated through the company’s TRANSPARENCY program, the largest head-to-head pivotal study versus BOTOX® to date. The product is approved for sale in the U.S. under the brand name Jeuveau® and in Canada under the brand name Nuceiva®, which launched in Europe in the second half of 2022, and received regulatory approval in Australia in January 2023.
About “Extra-Strength” Glabellar Line Study
The “Extra-Strength” Glabellar Line Study is a multicenter, double blind, randomized trial that is following 150 patients for up to 12 months at five study sites. The study includes two active controls – the currently approved 20 units of Jeuveau® and 20 units of BOTOX® Cosmetic – which will be compared to 40 units of Jeuveau®. In addition to evaluating the safety, efficacy and duration of effect, this study will also help assess the potential clinical tradeoffs for patients when using the longer duration option.
Investors Business Daily - paper edition...today 1/21/2023
RVNC is now #2 stock out of top 50 to buy with IBD
Carpe Diem, Daxxify: Revance Therapeutic Preps For An Exciting Year
Jan. 19, 2023 1:39 PM ETRevance Therapeutics, Inc. (RVNC)ABBV3 Comments
Summary
The global Botulinum Toxin market should reach $9.09 billion by 2029.
Technically, Revance Therapeutics, Inc.'s DAXXIFY is the first time in over 30 years that a truly innovative neurotoxin has been brought to the aesthetics market.
The outcome of the product's two quarter preliminary period looks auspicious for a great year.
I expect quick expansion and $800 million in Revance Therapeutics, Inc. revenue by 2030.
A woman receiving a botox injection in the forehead
BraunS/E+ via Getty Images
On January 9th, Revance Therapeutics, Inc. (NASDAQ:RVNC) disclosed higher-than-expected 4Q revenues from its RHA collection as well as its new cosmetic injection product, DAXXIFY (daxibotulinumtoxinA-lanm) ("Daxxify"). Its stock spiked 45%. Though DAXXIFY’s official commercial launch doesn’t happen until later this spring, the disclosure forced the market to again focus on just how impressive this new product is and to quickly recapture the upright enthusiasm it experienced last fall.
On September 8, the U.S. Food and Drug Administration approved Revance’s DAXXIFY for injection for the temporary improvement of moderate to severe frown lines in adults. It was a series of firsts: it was RVNC's first product to be cleared by the FDA; and it was the first time in over 30 years that a truly innovative neurotoxin has been brought to the aesthetics market.
What makes Daxxify unique? It can reduce the severity of frown lines for about six months. That is impressive. Six months is nearly double that of Botox, the reigning product, which is effective for 13 weeks. An injection of a purified form of botulinum toxin that paralyzes muscles, Botox revolutionized aesthetic medicine in 2002. In perpetual quest to look younger, it became a hit with celebrities and later the aging affluent. Wrinkle-smoothing botulinum toxin type A injections are now the most common non-invasive aesthetic procedure in the U.S. (And while --like "xerox"--they are all informally called “Botox,” the original BoNT-A injectables product has had three competitors FDA-approved for cosmetic use – Dysport, Jeuveau, and Xeomi.)
Revance now has a material advantage. It has a genuine brand distinction. It offers either a pricing advantage or (more likely) a scheduling advantage –i.e., less time in the doctor’s office. Now clients can choose to have the procedure discreetly once during the summer and once during winter holidays. Tucked deeply into extended vacation periods will help erase the anxiety of the procedure being too obvious –a major issue for on-the-fence prospective users (especially men). Away from the office for a full week or two, any new youthfulness will be less scrutinized and can be chalked up to more exercise and relaxation.
At the time of the approval, Goldman came out with the following note:
“We believe the imminent launch of Daxxify into the $1.7bn US cosmetic neuromodulator market has the potential to be disruptive, garnering share and potentially also helping to grow what remains a still relatively underpenetrated market.. . . We see potential for an even greater level of receptivity to Daxxify’s extended duration of efficacy within therapeutic market indications given the potential to effectively reduce the frequency of treatments versus currently approval botulinum toxin injections, by ~50% annually, with the consequent advantages to patients from a quality-of-life standpoint.”
The Opportunity
The approval has gifted RVNC with an amazing opportunity. The global total addressable market ("TAM") for aesthetic injection is projected to grow significantly over the next decade. One analyst sees the global Botulinum Toxin market reaching $9.09 billion by 2029, exhibiting a CAGR of 4.9% during the forecast period. In the first half of 2022 alone, sales of Botox, just for U.S. cosmetic use, came in at $862 million.
Wall Street analysts were quick to recognize the “better mousetrap” potential. Ken Cacciatore, a Cowen and Co analyst, has stated -- based on his fieldwork -- that physicians are expecting Daxxify to reach half the size of Botox in three years, and that it would easily exceed $1 billion in sales. Goldman is less sanguine; it sees Daxxify garnering 21% of the U.S. cosmetic neuromodulator market by 2025 and 35% by 2030. Mizuho is even more conservative – modeling U.S. cosmetics sales for Daxxify to reach about $506M in 2030, assuming a 15% U.S. market share.
Personally, I find myself more optimistic than Mizuho, with revenues of $820 million by 2030. Though this is a company that will lose money for another two years, I see massive profitability by 2025 and an EPS of around 10.35 by 2030:
Revance Therapeutics revenue estimates, 2022 - 2030
Revance Therapeutics revenue estimates, 2022 - 2030_ (Author)
One opportunity that has not been discussed is China, an unexpected place of big cosmetic demand. Like Brazil, it is becoming a major market.
The coastal cities slosh with disposable income obviously, but I was surprised to learn that cosmetic injection use among Chinese women starts much earlier than in the U.S., often in their late 20s. The market size of botulinum toxin in China was $487 million in 2018 and is expected to reach $2.07 billion by 2025 (with the compound annual growth rate from 2015 to 2018 being 30.8%). Things are accelerating. In 2019, botulinum toxin occupied 32.67% of the aesthetic medicine market in China, nearly doubling from its 2018 share. The Post-pandemic reopening will certainly help matters.
The four currently approved botulinum toxin products on the mainland: Botox, CBTX-A (China), Dysport (U.K.), and Letybo (South Korea). Botox and CBTX-A are the heavy hitters and split the market –occupying 46% and 53% respectively. Dysport and Letybo were newly approved in 2020 and currently have negligible market share.
The Chinese market is rife with illegal imports and the process of any injection application is slow. But the exceptional growth in the market, however, is suggestive of real "greenfield" opportunities for all players in the long term. I don’t expect Daxxify would make it into the Chinese market officially until 2025-2026, but I imagine it will prolong growth.
In addition, Revance expects further label expansion and investment in its aesthetics and therapeutic programs. The company submitted a sBLA in cervical dystonia for Daxxify in 4Q22 and looks to move the product into a Phase 3 in upper limb spasticity this year. Another avenue for growth: chronic migraine, an ~$800M+ US toxin opportunity.
I would argue that Daxxify’s longer-lasting 6 month profile will help it get a leg up in this therapeutic swath of treatment.
Revance Therapeutics --pipelines
Revance Therapeutics --pipelines (Revance website)
The PrevU
Mimicking its RHA filler rollout, Revance wanted its commercial launch of Daxxify to be gradual with a two quarter preview –its so-called PrevU.
In this “University schooling" period, the company has tapped a select group of key operatives (mostly physicians from their existing 5000 accounts) to gain hands-on experience at the company's central facility under the guidance of its medical affairs team. These trained operatives will then become corporate liaisons and educators implementing the full launch, which is expected to roll out later this Spring (2Q).
The good news: the PrevU program has had a robust start with around 400 select practice partners and thousands of patients treated, generating positive feedback, and revenue of between $10.5 million and $11.5 million. This is very auspicious for the full commercial launch, which doesn't happen until later this Spring (2Q 2023).
The market certainly responded --up 45% on the news. With that Daxxify revenue of $10.5 to $11.5 million and the unaudited Q4 RHA Collection revenue of between $34.0 million and $35.0 million, RVNC’s 4Q revenues broke above present analyst estimates of $42.4 million for the quarter.
Conclusion
Even if the U.S. falls into a recession in the coming months, I would argue Revance is poised to outperform. The older affluent that use Botox in the U.S. are less exposed to pricing issues or job cuts. As Goldman noted:
“[N]euromodulator products in particular are more resilient in the face of less favorable/challenging macroeconomic environments, than other elective cosmetic products.”
The deeper recession might even help Daxxify, as it might pressure users to reduce the number of costly elective doctor visits each year. I estimate the product will have a 25% premium to Botox, as it lasts longer and frees up time.
Final verdict: expect an exciting second half for Revance. In 2019, AbbVie purchased Allergan for $63 billion in a takeover of Botox that shocked the industry. Since then, Botox has been a goldmine for AbbVie. In 2021, "global Botox therapeutic net revenues" were $2.451 billion and "global Botox cosmetic net revenues" were $2.232 Billion.
From Morgan Stanley
We recognize that this is an N=1 and hence is unlikely representative of the broader aesthetic market dynamics (which would require a much larger sample size), but given the limited number of physicians with experience with Daxxify at this early point in the launch we felt that the below datapoints could be useful.
Current toxin/filler dynamics
Toxin share is 70% Botox, 20% Dysport with the remaining split between Xeomin and Jeuveau
Filler share is spread out amongst 8-9 different brands as the physician likes choice, given differences amongst the products
Daxxify PreVu program and early launch
To be considered for the Revance PreVu program and one-day training in Nashville, practices had to have used a certain level of the company's RHA filler products (which launched Sept 2020).
The physician initially ordered 25 bottles of Daxxify (the minimum), but recently ordered another 25 bottles. One bottle of Botox covers 5 injections, while one Daxxify bottle covers 2.5 injections.
No patient came in asking for Daxxify; however he offers it to all of his toxin patients and 9/10 have agreed to try it (as described above).
He noted its important to caveat to patients that while he expects an average response of 5-6 months, its a bell shaped distribution curve and also each person could have a different internal definition of response.
Pricing dynamics
Given Daxxify is a premium product he has priced it at a premium to Botox, but he is still unsure where the average injection price will ultimately land but believes the most appropriate place could be in the 50% range. This is consistent with our prior Daxxify profit analysis - see Exhibit 63.
From a high level perspective he noted that he will need longer follow-up data on Daxxify amongst his patients (likely 6-7 months out), in order to assess the impact of the product on the economics of his practice (i.e., any negative impact on other procedures/revenue from less frequent toxin visits). He caveated that the answer to this question will differ across every practice though given patient mix. In our view this implies that the pricing of Daxxify could vary widely amongst practices.
Longer-term market dynamics
If the differentiated profile of Daxxify holds up he expects to shift a vast majority of his toxin use over. This would more closely align with the Bull case we aligned in
2
our RVNC initiation (>30% market share).
He believes that a longer lasting toxin, such as Daxxify will likely help drive further market penetration, citing industry survey data from conferences and anecdotal evidence of prospective patients who decide not to use a toxin given they would have to come in multiple times a year and/or have needle phobia.
Revance trained 400+ with Daxxify and generated $10 to $11 million in Daxxify sales...average is $25,000 per person trained....In Q1 Revance is training 3000+ injectors...at $25,000 per person trained....so if you take 3000 times $25,000 = $75 million plus any additional sales from the 400 trained in December 2022..In Q2 2023 Revance is training the remaining 35,000 practices....
Just a thought...
https://finance.yahoo.com/news/revance-provides-daxxify-commercial-launch-130000788.html
Revance Provides an Update on DAXXIFY® Commercial Launch and Preliminary Fourth Quarter and Full Year 2022 Financial Results
Dew,
Has Revance published that they are attending the JPM Conference? If not, why?
I believe the FDA has approved the wording “Daxxify last on average 6 months and up to 9 months for some.”
Otherwise, Revance would not be allowed to include this wording on any Daxxify documents.