Botox’s almost complete domination of the neuromuscular blocking agent market has held off a couple of rivals; however, its new owner, Abbvie, might soon face a bigger challenge. Revance Therapeutics’ daxibotulinumtoxinA has been designed to be longer acting, and the first pivotal results in a medical setting seem to confirm this. The Aspen 1 trial in cervical dystonia found a median duration of response of 20-24 months; according to a cross-trial comparison put together by Revance, Botox wears off around six weeks sooner. This was a secondary measure of Aspen, which pitted two doses of daxi against placebo; the primary endpoint, change on a symptom score, was cleared with statistical significance. The inclusion of a Botox cohort would have made these findings more interesting, of course, although Revance’s reluctance to go head to head is understandable. The real battle will take place in the market, and Revance would not have wanted to risk handing an unwanted finding to Abbvie’s sales team. Revance needs to build a picture of a long-acting and safer option, and several trials due to report next year could help. The next hurdle is FDA approval, due next month in glabellar lines.