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Fayoux P, Dinomais M, Shaw H, Villain F, Schwartz D, Rondeau S, Letellier G, Auvin S. Glycopyrronium 320 μg/mL in children and adolescents with severe sialorrhoea and neurodisabilities: A randomized, double-blind, placebo-controlled trial. Dev Med Child Neurol 2024; 66:910-918. [PMID: 38214675 DOI: 10.1111/dmcn.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
AIM To investigate the efficacy, safety, and impact on quality of life (QoL) of an oral formulation of 320 μg/mL glycopyrronium designed for children. METHOD A double-blind, placebo-controlled SALIVA (Sialanar plus orAl rehabiLitation against placebo plus oral rehabilitation for chIldren and adolescents with seVere sialorrhoeA and neurodisabilities) trial was conducted. Children (3-17 years) with neurodisabilities and severe sialorrhoea (modified Teachers Drooling Scale ≥6) were randomized to 320 μg/mL glycopyrronium or placebo, in addition to non-pharmacological standard care. RESULTS Of 87 participants, 44 were aged 10 years or under and 43 had cerebral palsy. The primary endpoint, change in total Drooling Impact Scale (DIS) score from baseline to day 84, was significantly greater (improved) with 320 μg/mL glycopyrronium versus placebo (median [quartile 1, quartile 3] -29.5 [-44.5, 0] vs -1 [-16, 5]; p < 0.001), an effect also observed at day 28 (median - 25 vs -2; p < 0.01). Significant reduction in bibs/clothes used per day was seen with glycopyrronium versus placebo at day 84 (median - 2 vs 0; p < 0.01). Glycopyrronium significantly improved DIS items 9 and 10 related to the extent that drooling affects the child's and family's life (p ≤ 0.03). Adverse events were reported by 77.3% and 69.8% of children with glycopyrronium and placebo respectively; the most common treatment-related adverse event was constipation (20.5% and 16.3%). INTERPRETATION The formulation of 320 μg/mL glycopyrronium significantly improved drooling and reduced its impact on QoL, with good tolerability in children with neurodisabilities. WHAT THIS PAPER ADDS The formulation of 320 μg/mL glycopyrronium significantly improved Drooling Impact Scale score versus placebo at day 84. The formulation reduced the impact of drooling on the child's and family's quality of life. There were no safety or tolerability concerns with this specific formulation.
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Affiliation(s)
- Pierre Fayoux
- Department of Paediatric Otolaryngology Head Neck Surgery, Jeanne de Flandre Hospital, Lille, France
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France
| | - Mickael Dinomais
- Department of Physical Medicine and Rehabilitation, CHU Angers-Les Capucins, Angers, France
| | | | | | | | - Stéphane Rondeau
- Department of Early Medico-Social Action (CAMSP), CHU de Rouen, Rouen, France
| | - Guy Letellier
- Department of Physical Medicine and Rehabilitation, ESEAN-APF, Nantes, France
| | - Stéphane Auvin
- APHP, Service de Neurologie Pédiatrique, EpiCARE ERN membre, Hôpital Robert Debré, Paris, France
- INSERM NeuroDiderot, Université Paris-Cité, Paris, France
- Institut Universitaire de France (IUF), Paris, France
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Fayoux P, Dinomais M, Shaw H, Probert N, Villain F, Pouchain D, Texier N, Auvin S. Randomised, double-blind, placebo-controlled trial of glycopyrronium in children and adolescents with severe sialorrhoea and neurodisabilities: protocol of the SALIVA trial. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001913. [PMID: 37156563 PMCID: PMC10173983 DOI: 10.1136/bmjpo-2023-001913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Severe sialorrhoea is a common, distressing problem in children/adolescents with neurodisabilities, which has adverse health and social consequences. The SALIVA trial is designed to evaluate the efficacy and safety of a paediatric-specific oral solution of glycopyrronium along with its impact on quality-of-life (QoL), which has been lacking from previous trials of sialorrhoea treatments. METHODS AND ANALYSIS A double-blind, placebo-controlled, randomised phase IV trial is ongoing in several centres across France. Eighty children aged 3-17 years with severe sialorrhoea (≥6 on the modified Teachers Drooling Scale) related to chronic neurological disorders in whom non-pharmacological standard of care has already been implemented or has failed, will be recruited. Patients will be randomised 1:1 to receive a 2 mg/5 mL solution of glycopyrronium bromide (Sialanar 320 µg/mL glycopyrronium) or placebo three times daily during a 3-month blinded period. After Day 84, participants will be invited into a 6-month, open-label study extension period, where they will all receive glycopyrronium. The primary endpoint of the double-blind period will be the change from baseline to Day 84 in the Drooling Impact Scale (DIS), a validated measure to assess sialorrhoea. A series of secondary efficacy endpoints involving change in total DIS, specific DIS items and response (DIS improvement ≥13.6 points) will be analysed in a prespecified hierarchy. QoL data will be collected from parents, caregivers and patients where possible using specific DIS questions and DISABKIDS questionnaires. Safety endpoints, including adverse events, will be assessed throughout the trial periods. ETHICS AND DISSEMINATION In total, 87 children have been recruited and recruitment is now complete. Final results are expected by the end of 2023. Findings will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-005534-15.
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Affiliation(s)
- Pierre Fayoux
- Department of Paediatric Otolaryngology Head Neck Surgery, Jeanne de Flandre Hospital, Lille, France
| | - Mickael Dinomais
- Department of Physical Medicine and Rehabilitation, CHU Angers, Angers, France
| | - Helen Shaw
- Proveca Limited, Manchester, England, UK
| | | | | | - Denis Pouchain
- Department of General Practice, University of Tours, Tours, France
| | | | - Stéphane Auvin
- Service de Neurologie Pédiatrique, Robert-Debré Mother-Child University Hospital, Paris, France
- INSERM NeuroDiderot, Université Paris Cité, Paris, France
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Development of the Korean Version of the Drooling Infants and Preschoolers Scale. Occup Ther Int 2023. [DOI: 10.1155/2023/7082782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective. This study is aimed at translating and cross-culturally adapting the Drooling Infants and Preschoolers Scale (DRIPS) into Korean cultural context and examine the content validity and reliability of the Korean version, which is referred as K-DRIPS. Methods. An iterative forward-backward translation sequence of the DRIPS was performed by 20 Korean health professional experts (i.e., occupational therapists (OTs) and professors) with more than 10 years of experience. The study subjects were 77 children with cerebral palsy (CP) exhibiting drooling symptoms aged 2-7 years. They were recruited from two children’s rehabilitation hospitals in Korea and completed the K-DRIPS. The content validity and internal consistency of the K-DRIPS items were examined. Results. An assessment with 20 K-DRIPS items was adequately and cross-culturally adapted into Korea. All the items exhibited good content validity (content validity ratio range 4.00-4.95) and good internal consistency (Cronbach’s
). Conclusion. The study findings indicated that the K-DRIPS was successfully adapted to the Korean cultural context and demonstrated good psychometric properties. This instrument could be used for drooling assessment tool in Korean children with disabilities.
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Sforza E, Onesimo R, Leoni C, Giorgio V, Proli F, Notaro F, Kuczynska EM, Cerchiari A, Selicorni A, Rigante D, Zampino G. Drooling outcome measures in paediatric disability: a systematic review. Eur J Pediatr 2022; 181:2575-2592. [PMID: 35441248 PMCID: PMC9192436 DOI: 10.1007/s00431-022-04460-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Drooling, or sialorrhea, is a common condition in patients with cerebral palsy, rare diseases, and neurodevelopmental disorders. The goal of this review was to identify the different properties of sialorrhea outcome measures in children. Four databases were analysed in search of sialorrhea measurement tools, and the review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used for quality appraisal of the outcome measures. The initial search yielded 891 articles, 430 of which were duplicates. Thus, 461 full-text articles were evaluated. Among these, 21 met the inclusion criteria, reporting 19 different outcome measures that encompassed both quantitative measures and parent/proxy questionnaires. Conclusions: Among the outcome measures found through this review, the 5-min Drooling Quotient can objectively discriminate sialorrhea frequency in patients with developmental disabilities. The Drooling Impact Scale can be used to evaluate changes after treatment. The modified drooling questionnaire can measure sialorrhea severity and its social acceptability. To date, the tests proposed in this review are the only tools displaying adequate measurement properties. The acquisition of new data about reliability, validity, and responsiveness of these tests will confirm our findings. What is Known: • Although sialorrhea is a recognized problem in children with disabilities, especially those with cerebral palsy (CP), there is a lack of confidence among physicians in measuring sialorrhea. What is New: • Few sialorrhea measures are available for clinicians that may guide decision-making and at the same time have strong evidence to provide confidence in the results. • A combination of both quantitative measures and parent/proxy questionnaires might provide an adequate measurement of sialorrhea in children.
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Affiliation(s)
- E. Sforza
- Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
| | - R. Onesimo
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - C. Leoni
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - V. Giorgio
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - F. Proli
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - F. Notaro
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - E. M. Kuczynska
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Cerchiari
- Feeding and Swallowing Services Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - A. Selicorni
- Department of Paediatrics, ASST Lariana, Presidio S. Fermo, Como, Italy
| | - D. Rigante
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy ,Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
| | - G. Zampino
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy ,Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
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