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There’s more to Botox than ironing out the wrinkles
Blogs are not edited by PJ staff*. The opinions expressed in this blog do not necessarily reflect those of The Pharmaceutical Journal.
*Blog pieces that have previously been printed in the PJ and Clinical Pharmacist are edited.
By Laura Burley
15 May 2012
When riding the bus to work, one of my guilty pleasures is reading the Metro. However last week one headline did catch my eye and this was that the NHS is set to fund botox (botulinum toxin type A) for migraines.
This brought back memories of last year and a smiley drug rep giving our hospital a small talk on the update of Botox and its new approved use for migraines. After the talk I really couldn’t believe it, given that my own knowledge of botox was that it was responsible for the expression-less faces of many celebrities.
However it was during its use for cosmetic purposes in which its significant reduction on headache frequency in sufferers was discovered. A couple of years later and NICE has now produced draft guidance of it being used as a last line agent in the prophylaxis of migraines. The use, however, will be restricted to chronic migraines (headaches for 15 days a month of which of 8 are migraines). It will also only be an option for patients that have tried three different types of medicines and the headaches are not the result of medication overuse.
The process sounds to me also sounds a little painful and complicated, requiring 31 or more injections to different sites around the face, head or neck. However the results in clinical studies are promising and could be more than worth it to help improve the quality of life of chronic migraine suffers. Furthermore it is interesting to learn of the other indications Botox has, such as improvement of spasticity in children with cerebral palsy and use in involuntary facial spasms. Whilst working on the surgical wards I even saw it being used for the treatment of anal fissures. It makes me wonder what other alternative indications are yet to be discovered for existing medicinal products.
Boosting pharmaceutical research and development
The final point of Laura's blog is the most important - indeed, there are hundreds of medicines for which multiple useful indications probably exist. But how can we encourage the generation of the necessary clinical evidence to support such uses when pharmaceutical companies have such a short period of time in which to reap the rewards of their investments? We need to overhaul the patent and copyright laws so that commercial parties have longer to develop these drugs and longer to make their return, thus providing lower prices initially (although I appreciate greater profits overall). This would need to be done on an international basis such is the nature of the global pharmaceutical business. But this can be done, just look at how creative copyrights have been extended numerous times in different countries. We need to change the legal and regulatory environment to support our pharmaceutical industry and promote useful clinical developments.
Declaration: Academic and NHS (commissioning) pharmacist. Participated in several non-promotional, advisory, and market-research events organised directly and indirectly by pharmaceutical companies.