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Morgado-Carrasco D, de Lucas R. [Translated article] Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T356-T367. [PMID: 38331172 DOI: 10.1016/j.ad.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/05/2023] [Indexed: 02/10/2024] Open
Abstract
Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.
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Affiliation(s)
- D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, Spain.
| | - R de Lucas
- Servicio de Dermatología, Hospital la Paz, Madrid, Spain
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Morgado-Carrasco D, de Lucas R. Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:356-367. [PMID: 37714301 DOI: 10.1016/j.ad.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.
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Affiliation(s)
- D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Dermatología, Hospital de Figueres, Fundació Salut Empordà, Figueres, España.
| | - R de Lucas
- Servicio de Dermatología, Hospital la Paz, Madrid, España
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Kaufman AR, Gulati S, Pula JH, Janetos TM, Cherayil NR, Chiu E, Shepherd EA, Golnik KC, Garcia-Valenzuela E, MacIntosh PW, Johnson BT, Curnyn KM. Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis. J Neuroophthalmol 2022; 42:530-534. [PMID: 35427257 PMCID: PMC9508283 DOI: 10.1097/wno.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Topical glycopyrronium tosylate (GT) is an anticholinergic medication for treatment of axillary hyperhidrosis. Pharmacologic mydriasis and anisocoria from topical GT has been reported and may be underrecognized. This study aims to clinically characterize patients presenting with pharmacologic mydriasis from exposure to this medication. METHODS This study is a retrospective observational case series. A multicenter chart review of 16 patients diagnosed with pharmacologic mydriasis secondary to topical GT was performed. RESULTS Eight patients (50.0%) were age 18 years and younger, and 14 patients (87.5%) were female. Unilateral mydriasis (anisocoria) occurred in 14 patients (87.5%). Fourteen patients (87.5%) did not initially volunteer topical GT as a "medication," and the history of topical GT exposure needed to be elicited with further questioning. Hand hygiene details were known for 12 patients, and all reported that they did not wash their hands after GT application. Six patients (37.5%) were soft contact lens users. One patient had possible exposure through a family member's use of the medication. Ocular symptoms were common (blurry vision [11 patients, 68.8%] and eye dryness [7 patients, 43.8%]), but systemic anticholinergic symptoms were uncommon (such as constipation [1 patient, 6.3%] and urinary symptoms [3 patients, 18.8%]). CONCLUSIONS Mydriasis associated with topical GT seems to be a consequence of local exposure rather than systemic toxicity. Because patients may not volunteer topical GT as a medication, eliciting a history of exposure often requires further specific questioning. Soft contact lens wear and poor postapplication hand hygiene seem to be associated with mydriasis in GT use.
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Affiliation(s)
- Aaron R. Kaufman
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Shawn Gulati
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - John H. Pula
- NorthShore University Health System, Evanston, IL, USA
| | - Timothy M. Janetos
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neena R. Cherayil
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Chiu
- Des Peres Eye Center, Des Peres, MO, USA
| | - E. Annie Shepherd
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
| | - Karl C. Golnik
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Eye Institute, Cincinnati, OH, USA
| | | | - Peter W. MacIntosh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Brooke T. Johnson
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Kimberlee M. Curnyn
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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Henning MAS, Bouazzi D, Jemec GBE. Treatment of Hyperhidrosis: An Update. Am J Clin Dermatol 2022; 23:635-646. [PMID: 35773437 DOI: 10.1007/s40257-022-00707-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
Hyperhidrosis is a dermatosis presenting as pathologically excessive focal or generalized sweating. The stigmatizing nature of hyperhidrosis may cause patients to feel embarrassment and apprehension about their symptoms and experience a significant decrease in well-being. Severe cases of hyperhidrosis can also increase the risk of developing psychiatric and somatic comorbidities. Conventional non-surgical treatments of hyperhidrosis include aluminum salts, iontophoresis, botulinum toxin injections, and oral glycopyrronium. In recent years, new topical anticholinergic medications and devices have emerged that may improve the patients' symptoms and even prevent the development of comorbidities. The treatment of hyperhidrosis can be a complex matter and may require the combination of several therapies. The purpose of this paper was to firstly review the literature on existing non-surgical treatment options for hyperhidrosis, and secondly provide a stepwise approach to investigating and treating patients with hyperhidrosis.
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Affiliation(s)
- Mattias A S Henning
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
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Gregoriou S, Markantoni V, Campanati A, Martina E, Offidani A, Kouris A, Platsidaki E, Bokotas H, Stratigos A, Rigopoulos D, Kontochristopoulos G. Treatment of Axillary Bromhidrosis with Topical 2% Glycopyrronium Bromide Cream: A Prospective, Non-randomized, Open-label Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E61-E63. [PMID: 34980961 PMCID: PMC8675343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Topical glycopyrrolate is a well-established therapeutic option for focal hyperhidrosis; however, there are no data on its efficacy in the treatment of bromhidrosis. OBJECTIVES The objective of this open-label, non-randomized study was to investigate the efficacy and safety of a galenic formulation of 2% glycopyrronium bromide cream, in the treatment of bromhidrosis. METHODS Nineteen patients with bromhidrosis were prescribed a 2% glycopyrronium bromide cream, to apply in both axillae, every night, for 12 weeks. Malodor was assessed on a four-point scale. Scores for the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and the Hospital Anxiety and Depression Scale (HADS) were recorded at baseline and after 12 weeks. RESULTS Statistically significant improvements in malodor and HDSS, DLQI, and HADS scores, respectively, were observed after treatment. One patient reported irritation at the site of application and another reported mydriasis, which resolved spontaneously. All but one of the patients declared that they were either completely (52/6%) or partially (42.1%) satisfied regarding the treatment. CONCLUSION Our results indicate that 2% glycopyrronium bromide cream is effective and safe for 12 weeks of application in patients with axillary bromhidrosis.
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Affiliation(s)
- Stamatios Gregoriou
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Vasiliki Markantoni
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Anna Campanati
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Emanuela Martina
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Annamaria Offidani
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Anargyros Kouris
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Eftychia Platsidaki
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Haralambos Bokotas
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Alexandros Stratigos
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - Dimitrios Rigopoulos
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
| | - George Kontochristopoulos
- Drs. Gregoriou, Markantoni, Kouris, Platsidaki, Stratigos, and Rigopoulos are with the Faculty of Medicine, 1st Department of Dermatology-Venereology at Andreas Sygros Hospital, National and Kapodistrian University in Athens, Greece
- Drs. Campanati, Martina, and Offidani are with the Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University in Ancona, Italy. Bokotas and Kontochristopoulos are with the Department of Dermatology-Venereology, Andreas Sygros Hospital in Athens, Greece
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Yokozeki H, Fujimoto T, Wanatabe S, Ogawa S, Fujii C. Topical glycopyrronium tosylate in Japanese patients with primary axillary hyperhidrosis: A randomized, double-blind, vehicle-controlled study. J Dermatol 2021; 49:86-94. [PMID: 34636057 PMCID: PMC9293301 DOI: 10.1111/1346-8138.16188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/19/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022]
Abstract
Glycopyrronium tosylate cloth, an anticholinergic drug, has been approved for the topical treatment of primary axillary hyperhidrosis in the USA, but its effects in Japanese patients have not been previously investigated. This 4-week, randomized, double-blind, vehicle-controlled, multicenter study was conducted to evaluate the efficacy and safety of glycopyrronium tosylate cloth for primary axillary hyperhidrosis patients in Japan. Eligible patients, who were ≥9 years of age and had primary axillary hyperhidrosis ≥6 months, with gravimetrically-measured sweat production ≥50 mg/5 min, and Hyperhidrosis Disease Severity Scale ≥3 (moderate) were randomized 1:1:1 to once daily topical glycopyrronium tosylate 3.75%, 2.5%, or vehicle. Overall, 497 patients (163 in the glycopyrronium tosylate 3.75% group, 168 in the glycopyrronium tosylate 2.5% group, and 166 in the vehicle group, hereinafter in this order) were randomized. Statistically higher proportions of patients in the glycopyrronium tosylate groups achieved ≥2-point improvement in Hyperhidrosis Disease Severity Scale and ≥50% reduction in sweat production from baseline versus vehicle at week 4 (51.6%, 41.1%, and 16.4%, respectively; p < 0.001 in both cases). Higher responder rates in the glycopyrronium tosylate groups compared with the vehicle group occurred as early as week 1. The most common treatment-emergent adverse events in patients treated with glycopyrronium tosylate were photophobia, mydriasis, thirst, and dysuria. Most treatment-emergent adverse events were mild as determined by the investigators. The incidence of treatment-emergent adverse events leading to treatment modification was low in the three groups. The 4-week use of topical glycopyrronium tosylate improved the patient-reported outcome measure Hyperhidrosis Disease Severity Scale and objectively-evaluated sweat production with a favorable benefit/risk profile.
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Affiliation(s)
- Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoko Fujimoto
- Ikebukuro Nishiguchi Fukurou Dermatology Clinic, Tokyo, Japan
| | | | - Shuhei Ogawa
- Clinical Development Department, Maruho Co., Ltd., Kyoto, Japan
| | - Chie Fujii
- Clinical Development Department, Maruho Co., Ltd., Kyoto, Japan
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Abstract
Primary hyperhidrosis, an idiopathic disease that commonly affects the palms, soles, axillae, or craniofacial region, is characterized by perspiration in excess of what is required for physiologic cooling. This disease begins in childhood or adolescence and negatively impacts emotional, physical, and psychologic well-being. This review explores current therapeutic options for primary hyperhidrosis in the pediatric population, including topical therapies, oral therapies, non-surgical and procedural interventions, and adjunctive therapies. In addition, this review identifies new and emerging treatments and highlights the need for further research and therapeutic options for this impactful disease.
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Affiliation(s)
- Courtney Remington
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Jennifer Ruth
- Dell Children's Medical Group, Pediatric and Adolescent Dermatology, Austin, TX, USA.,Dell Medical School, Division of Dermatology, The University of Texas at Austin, Austin, TX, USA
| | - Adelaide A Hebert
- McGovern Medical School, Departments of Dermatology and Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Pariser DM, Lain EL, Mamelok RD, Drew J, Mould DR. Limited Systemic Exposure with Topical Glycopyrronium Tosylate in Primary Axillary Hyperhidrosis. Clin Pharmacokinet 2021; 60:665-676. [PMID: 33433785 PMCID: PMC8113176 DOI: 10.1007/s40262-020-00975-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Glycopyrronium tosylate (GT; Qbrexza® [glycopyrronium] cloth, 2.4%) is a topical anticholinergic approved (USA) for primary axillary hyperhidrosis in patients aged ≥ 9 years. OBJECTIVE The objective of this study was to compare the pharmacokinetics and safety of GT to oral glycopyrrolate (phase I study) and assess the relationship between glycopyrronium pharmacokinetics and anticholinergic-related adverse events or efficacy with population pharmacokinetics using data from two phase II studies. METHODS In the phase I study, study staff applied GT to axillae of patients with primary axillary hyperhidrosis (aged 9-65 years) once daily (5 days); oral glycopyrrolate was administered to healthy adults (aged 18-65 years) every 8 hours (15 days). In the phase II studies (NCT02016885 [20 December, 2013], NCT02129660 [2 May, 2014]), adults with primary axillary hyperhidrosis applied topical glycopyrronium (0.8-3.2%) or vehicle to axillae once daily (4 weeks). Pharmacokinetic and adverse event data were collected in all studies. RESULTS Glycopyrronium pharmacokinetic parameters were similar between adult and pediatric patients treated with GT; there was no evidence of accumulation. Systemic absorption of glycopyrronium was lower with GT vs oral glycopyrrolate. No anticholinergic-related adverse events occurred with GT in the phase I study, while dry mouth and nasal dryness occurred with oral glycopyrrolate; anticholinergic adverse events occurred in the phase II studies. In the population pharmacokinetic analysis, frequency/severity of anticholinergic-related adverse events increased with higher glycopyrronium concentration; no relationship was observed between efficacy and pharmacokinetic measures. CONCLUSIONS These studies indicate limited absorption of GT compared to oral glycopyrrolate and a low risk of anticholinergic adverse events with proper GT administration when following instructions for use (wipe each underarm once with same cloth, wash hands, avoid ocular contact).
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Affiliation(s)
- David M Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc., 6160 Kempsville Circle, Suite 200A, Norfolk, VA, 23502, USA.
| | - Edward L Lain
- Austin Institute for Clinical Research, Austin, TX, USA
| | | | - Janice Drew
- Dermira, Inc., a wholly owned subsidiary of Eli Lilly and Company, Menlo Park, CA, USA
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Soeberdt M, Kilic A, Abels C. Current and emerging treatments targeting the neuroendocrine system for disorders of the skin and its appendages. Exp Dermatol 2020; 29:801-813. [DOI: 10.1111/exd.14145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/09/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Ana Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel Bielefeld Germany
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10
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Hebert AA, Glaser DA, Green L, Hull C, Cather J, Drew J, Gopalan R, Pariser DM. Long-term efficacy and safety of topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Post hoc pediatric subgroup analysis from a 44-week open-label extension study. Pediatr Dermatol 2020; 37:490-497. [PMID: 32147881 PMCID: PMC7383486 DOI: 10.1111/pde.14135] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Glycopyrronium tosylate (GT) cloth, 2.4% is a topical anticholinergic approved in the United States for primary axillary hyperhidrosis in patients ≥9 years. This post hoc analysis evaluated long-term response (efficacy and safety) in pediatric patients (≥9 to ≤16 years) to GT in the 44-week, open-label extension (NCT02553798) of two, phase 3, double-blind, vehicle-controlled, 4-week trials (NCT02530281, NCT02530294). METHODS In the double-blind trials, patients ≥9 years with primary axillary hyperhidrosis were randomized 2:1 to once-daily GT:vehicle. Those who completed the study could receive open-label GT for up to an additional 44 weeks. Safety assessments included treatment-emergent adverse events (TEAEs) and local skin reactions (LSRs). Descriptive efficacy assessments included gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale response (≥2-grade improvement), and Children's Dermatology Life Quality Index. RESULTS Of 43 pediatric patients completing either double-blind trial, 38 (88.4%) entered the open-label extension (age, years: 9 [n = 1], 12 [n = 2], 13 [n = 7], 14 and 15 [n = 9 each], 16 [n = 10]). The safety profile observed was similar to the double-blind trials. Most TEAEs (>95%) were mild/moderate, related to anticholinergic activity, and infrequently led to discontinuation (n = 1/38 [2.6%]). No pediatric patients experienced a serious TEAE. Most anticholinergic TEAEs did not require a dose modification and resolved within 7 days. Approximately, one-third of patients (n = 13/38 [34.2%]) had LSRs; most were mild/moderate in severity. Improvements in efficacy measures were maintained from the double-blind trials. CONCLUSIONS Long-term, once-daily GT for up to 48 weeks (4-week double-blind plus 44 week open label) provides a noninvasive, well-tolerated treatment option for pediatric patients with primary axillary hyperhidrosis.
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Affiliation(s)
| | | | - Lawrence Green
- George Washington University School of Medicine, Washington, District of Columbia, United States
| | - Cheryl Hull
- Northwest Arkansas Clinical Trials Center, PLLC, Rogers, Arkansas
| | - Jennifer Cather
- Modern Research Associates, PLLC, Dallas, Texas, United States
| | - Janice Drew
- Dermira, Inc., Menlo Park, California, United States
| | | | - David M Pariser
- Eastern Virginia Medical School, Virginia Clinical Research, Inc., Norfolk, Virginia, United States
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Seto S, Teo AA, Walsh RD. Pharmacologic mydriasis in an infant following parental use of topical glycopyrronium tosylate. J AAPOS 2019; 23:359-361. [PMID: 31683011 DOI: 10.1016/j.jaapos.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
We report the case of a 2-month-old boy with unilateral pharmacologic mydriasis from inadvertent exposure to glycopyrronium after parental use of glycopyrronium wipes. Clinician familiarity with the potential effects of glycopyrronium exposure may aid in the recognition, diagnosis, and prevention of pharmacologic mydriasis as well as the reduction of costly and unnecessary evaluations.
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Affiliation(s)
- Steven Seto
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alison A Teo
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ryan D Walsh
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Abstract
Glycopyrronium tosylate (Qbrexza™) is available as single-use, pre-moistened cloths and has been approved in the USA for the topical treatment of primary axillary hyperhidrosis in adults and children ≥ 9 years of age. Glycopyrronium tosylate is effective in reducing patient-reported severity of disease and gravimetrically measured sweat production in this patient population; improvements have been shown to be maintained throughout long-term treatment (up to 48 weeks). Glycopyrronium tosylate is generally well tolerated, with most adverse events being mild to moderate in severity. Glycopyrronium tosylate thus provides a self-administered, non-invasive alternative to topical antiperspirant therapy and clinic-based treatments in adults with primary axillary hyperhidrosis, and is the only alternative to topical antiperspirants specifically approved in children and adolescents ≥ 9 years of age.
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Affiliation(s)
- Yvette N Lamb
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Glaser DA, Hebert AA, Nast A, Werschler WP, Green L, Mamelok RD, Quiring J, Drew J, Pariser DM. A 44-Week Open-Label Study Evaluating Safety and Efficacy of Topical Glycopyrronium Tosylate in Patients with Primary Axillary Hyperhidrosis. Am J Clin Dermatol 2019; 20:593-604. [PMID: 31111409 PMCID: PMC6687675 DOI: 10.1007/s40257-019-00446-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Glycopyrronium tosylate is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged ≥ 9 years (Qbrexza™ [glycopyrronium] cloth, 2.4%). OBJECTIVE This 44-week open-label extension study assessed glycopyrronium tosylate safety and descriptive efficacy in patients completing one of two, phase III, double-blind, vehicle-controlled, 4-week trials (NCT02530281; NCT02530294). METHODS Patients aged ≥ 9 years with primary axillary hyperhidrosis were randomized 2:1 (glycopyrronium tosylate: vehicle, once daily) in the double-blind trials. Completers could receive open-label glycopyrronium tosylate for up to an additional 44 weeks. Treatment-emergent adverse events and local skin reactions were assessed. Descriptive efficacy assessments were gravimetrically measured sweat production, Hyperhidrosis Disease Severity Scale responder rate (≥ 2 grade improvement), and Dermatology Life Quality Index/children's Dermatology Life Quality Index. RESULTS Of 651 patients completing the double-blind trials, 564 (86.6%) entered the open-label extension; 550 were analyzed. Most patients experiencing treatment-emergent adverse events had mild or moderate events (> 90%). Discontinuation because of treatment-emergent adverse events remained low and relatively stable, with a cumulative rate of 8.0% (44/550) over 44 weeks. Common treatment-emergent adverse events (> 5%) were dry mouth (16.9%), vision blurred (6.7%), application-site pain (6.4%), nasopharyngitis (5.8%), and mydriasis (5.3%). Most patients (67.5%) had no local skin reactions; those occurring were predominantly mild/moderate. Glycopyrronium tosylate efficacy was maintained throughout the trial; at week 44, the Hyperhidrosis Disease Severity Scale responder rate was 63.2%, and improvements from baseline (double blind) in sweat production were - 71.3% and 8.7 ± 6.2/6.2 ± 4.9 for Dermatology Life Quality Index/children's Dermatology Life Quality Index. CONCLUSIONS Daily long-term application of glycopyrronium tosylate for up to 48 weeks (double blind plus open label) was generally well tolerated and efficacy was maintained. No new safety signals emerged. TRIAL REGISTRY Clinicaltrials.gov NCT02553798.
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Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials. Pediatr Dermatol 2019; 36:424. [PMID: 31099927 PMCID: PMC6885915 DOI: 10.1111/pde.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pariser DM, Hebert AA, Drew J, Quiring J, Gopalan R, Glaser DA. Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Patient-Reported Outcomes from the ATMOS-1 and ATMOS-2 Phase III Randomized Controlled Trials. Am J Clin Dermatol 2019; 20:135-145. [PMID: 30378087 PMCID: PMC6516143 DOI: 10.1007/s40257-018-0395-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Glycopyrronium tosylate (GT) is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged ≥ 9 years. GT was evaluated for primary axillary hyperhidrosis in replicate, randomized, double-blind, vehicle-controlled, phase III trials. GT reduced sweating severity and production versus vehicle and was generally well tolerated. OBJECTIVE Our objective was to evaluate patient-reported outcomes (PROs) from these trials. METHODS Patients aged ≥ 9 years with primary axillary hyperhidrosis ≥ 6 months, gravimetrically measured sweat production ≥ 50 mg/5 min in each axilla, Axillary Sweating Daily Diary (ASDD) Item 2 severity score ≥ 4, and Hyperhidrosis Disease Severity Scale (HDSS) score ≥ 3 were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. The 4-item ASDD, 6 Weekly Impact (WI) items, Patient Global Impression of Change (PGIC), HDSS, and Dermatology Life Quality Index (DLQI) were utilized. RESULTS In the pooled population, 463 patients were randomized to GT and 234 to vehicle; 426 (92.0%) and 225 (96.2%) completed the trials. At baseline, most patients considered their axillary sweating to be at least moderate in severity, impact, and bothersomeness (ASDD items 2, 3, and 4, respectively). Improvement was substantially greater for GT than for vehicle at every study week, and, at week 4, ASDD scores improved from baseline by 62.6 versus 34.0% (severity), 65.5 versus 40.3% (impact), and 65.4 versus 39.0% (bothersomeness). Improvements favoring GT versus vehicle also occurred for WI items, PGIC, HDSS, and DLQI. CONCLUSIONS PRO results demonstrated that GT reduced the disease burden of primary axillary hyperhidrosis. TRIAL REGISTRATION Clinicaltrials.gov; ATMOS-1 (NCT02530281), ATMOS-2 (NCT02530294).
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Affiliation(s)
- David M Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc., 6160 Kempsville Circle, Suite 200A, Norfolk, VA, 23502, USA.
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Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. J Am Acad Dermatol 2019; 80:128-138.e2. [DOI: 10.1016/j.jaad.2018.07.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/17/2018] [Accepted: 07/02/2018] [Indexed: 11/23/2022]
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Hebert AA, Glaser DA, Green L, Werschler WP, Forsha DW, Drew J, Gopalan R, Pariser DM. Glycopyrronium tosylate in pediatric primary axillary hyperhidrosis: Post hoc analysis of efficacy and safety findings by age from two phase three randomized controlled trials. Pediatr Dermatol 2019; 36:89-99. [PMID: 30451318 PMCID: PMC6587744 DOI: 10.1111/pde.13723] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hyperhidrosis in pediatric patients has been understudied. Post hoc analyses of two phase 3 randomized, vehicle-controlled, 4-week trials (ATMOS-1 [NCT02530281] and ATMOS-2 [NCT02530294]) were performed to assess efficacy and safety of topical anticholinergic glycopyrronium tosylate (GT) in pediatric patients. METHODS Patients had primary axillary hyperhidrosis ≥ 6 months, average Axillary Sweating Daily Diary (ASDD/ASDD-Children [ASDD-C]) Item 2 (sweating severity) score ≥ 4, sweat production ≥ 50 mg/5 min (each axilla), and Hyperhidrosis Disease Severity Scale (HDSS) ≥ 3. Coprimary end points were ≥ 4-point improvement on ASDD/ASDD-C Item 2 (a validated patient-reported outcome) and change in gravimetrically measured sweat production at Week 4. Efficacy and safety data are shown through Week 4 for the pediatric (≥ 9 to ≤ 16 years) vs older (> 16 years) subgroups. RESULTS Six hundred and ninety-seven patients were randomized in ATMOS-1/ATMOS-2 (GT, N = 463; vehicle, N = 234); 44 were ≥ 9 to ≤ 16 years (GT, n = 25; vehicle, n = 19). Baseline disease characteristics were generally similar across subgroups. GT-treated pediatric vs older patients had comparable improvements in ASDD/ASDD-C Item 2 (sweating severity) responder rate, HDSS responder rate (≥ 2-grade improvement]), sweat production, and quality of life (mean change from Baseline in Dermatology Life Quality Index [DLQI]/children's DLQI), with greater improvement vs vehicle. Treatment-emergent adverse events were similar between subgroups, and most were mild, transient, and infrequently led to discontinuation. CONCLUSIONS Topical, once-daily GT improved disease severity (ASDD/ASDD-C, HDSS), sweat production, and quality of life (DLQI), with similar findings in children, adults, and the pooled population. GT was well tolerated, and treatment-emergent adverse events were qualitatively similar between subgroups and consistent with other anticholinergics.
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Affiliation(s)
| | | | - Lawrence Green
- George Washington University School of MedicineWashingtonDistrict of Columbia
| | | | | | | | | | - David M. Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc.NorfolkVirginia
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