Hi Dr. Pierone, I have one suggestion and one question. My suggestion is that you consider recommending Artefill to people who are considering injectable fillers to correct facial lipoatrophy. It worked really well for me and it's supposed to last for about 10 years. My question is what is your clinical experience with using Serostim to combat intra-abdominal lipodystrophy and do you have any suggestions as to how to get insurance to pay for it? Do you know if it will be approved for this purpose in the future? (presently it's only FDA-approved for wasting, not lipo)

Hello and thanks for posting.

I think Artefill is a terrific product and works quite well for HIV facial lipoatrophy (although it is off label). But the reason that it does not come up much in discussion is really related to the cost. The cost of Artefill to U.S. physicians is about $600 per 0.8 ml syringe. The typical charge to patient per syringe is $1200 (although we charge $800/syringe when doing multiple syringes). To correct moderate facial lipoatrophy takes at least 10 syringes so this would be a minimum of $8000 to $12,000.

Both Sculptra and Radiesse have patient assistance programs (which 90 percent of our patients qualify for) and this enables us to offer treatment that is affordable. However, for those who do not qualify for the patient assistance program an argument could be made that Artefill might be more cost-effective in the long run. It is a permanent product and thus has long-term durability. Sculptra tends to last longer than Radiesse, but there are scant long-term data (greater than 2 years) yet for all of these agents.

With regard to Serostim, I doubt that FDA approval will ever happen for lipohypertrophy (even though it clearly works). The company did the studies and approval was denied. I assume that they would have to do most costly trials and they probably will not spend the money to pursue this. Tesamorelin (a growth hormone releasing hormone analogue) is seeking approval for lipohypertrophy so this new competition would be another reason that the company would not move forward on additional Serostim trials. I have not been very successful in my attempts to have private insurance companies approve Serostim because of this lack of FDA approval. They typically turn down requests unless the person has HIV-related wasting.

I hope this information helps and best of luck!