I'll add my 2 cents to the Daxi uptake thread in neurology and also to the mindset of a neurologist. I'll also add a couple points about patients.
Although I subspecialize in Neuroimmunology (75-80% of practice, mostly MS), I know about Daxi and how it might fit in my practice. I do about 18 Botox/Xeomin patients quarterly so I inject toxin but do not consider it a subspecialty. 10 are migraine (all Botox), 1 writer's cramp, 1 lower limb focal dystonia, 4 MS spasticity, 1 HFS and 1 cervical dystonia/torticollis. Our practice does >150 migraine Botox patients and around 100 other toxin patients. I asked my partner, who is very knowledgeable and who does the most non-migraine toxin (and like me and your doctor, some research) about Daxi a couple weeks ago. They were unaware of the drug name, results, PDUFA date or other details though aware a longer toxin was in the works. They do not invest in individual stocks having most assets with an adviser and likely never seen Biotech Values on Ihub. When I discussed it , they were vaguely interested for some of the patients but not excited. I learned about Daxi from this board not a journal or conference. Few doctors are on Ihub or other boards. The drug is not approved in our field, there are no neuro reps, no ads in journals, no emails, there are no CD patients clamoring for its use. At least 1/10 of this board's posts are RVNC so of course those who visit this site know about it - and may even suffer from associated cognitive bias I think your neurologist is typical, few know about Daxi at this point. Once he knows more, he will likely use some. IMO many patients would also rather wait until a drug is out a while even if there are fewer shots - others will be very aware and ask him about it.
Where will it fit into my practice - I would definitely use it for migraine once the insurers cover it for that indication (which will not occur until the FDA approves it). Has Revance ever commented about Daxi in migraine? My understanding is that Allergan/Abbvie still has an enforceable patent for that use. I won't be using it for my CD patient anytime soon - it took us 5 series of injections 8 or 9 years ago to come up with the winning combination of site and dose. She would be fine with this. I would consider a switch at some point. I would definitely use it in my MS spasticity (3 upper, 1 lower) patients and travel is difficult for 3 of them so q6 months would be a real benefit. It may not be covered by insurance so I may have no choice. None of my non-migraine patients would pay out of pocket.
Another couple of points and this ties into jbogs online snooping. A patient's perception about durability may have more to do with mindset and less with reality. With infusion therapies in neuro and rheum practices, there is a very common phenomenon known as the 'crap gap' when patients feel worse at the end of each cycle. I.e. in my field patients are more tired the last week of each natalizumab or last month of each ocrelizumab infusion - despite proof that the drug is still working (no exacerbation, studies showing Tysabri treated patient's cells do not cross BBB until 3 months off drug, CD20 counts still zero at 6 months in the complaining patient). I don't know if this is physiologic (due to a secondary action that wears off faster) or psychological. An online sample may not represent a real sample. A couple of my migraine Botox patients do great for 10 weeks and poorly the last 2 - real or imagined? My CD patient does great the whole 3 months. My writer's cramp patient just calls when she's ready for next series as each one is lasting 5-6 months completely and well enough an additional month.
