Highlights from

WCD 2019

World Congress of Dermatology

Milan 10-15 June 2019

Glycopyrronium decreases sweat production and improves quality of life

Hyperhidrosis is a prevalent chronic condition, also affecting children, with a prevalence of approximately 4.8% in the United States. Two phase 3 trials and a subsequent extension study showed that glycopyrronium tosylate, when applied once-daily for up to 48 weeks, was generally well tolerated, reduced sweating severity, decreased sweat production, and improved quality of life [1]. The findings in paediatric patients were similar.

In hyperhidrosis, sweat production exceeds that which is necessary to maintain normal thermal homeostasis. The negative impact of hyperhidrosis on quality of life is comparable to, or greater than the impact of psoriasis or eczema. Anxiety and depression are >3.5 times more prevalent among patients with hyperhidrosis than the general population. Although hyperhidrosis has a substantial negative impact on patients, it remains underdiagnosed and undertreated.

Nonsurgical and surgical options

Hyperhidrosis treatments have included nonsurgical and surgical options that generally work to:

• block sweat from reaching the skin surface, such as antiperspirants;

• inhibit neuronal transduction to sweat glands, such as onabotulinum toxin A or oral anticholinergic drugs; or

• destroy the sweat glands, such as thermal ablation or surgical removal. Some treatments have an unknown mechanism of action, such as iontophoresis.

Glycopyrronium tosylate (GT) is a topical anticholinergic approved by the United States Food and Drug Administration for the treatment of primary axillary hyperhidrosis in patients ≥9 years old (glycopyrronium cloth, 2.4%, for topical use). This drug is applied once daily to the axillae.

Phase 3 and extension study

The phase 3 ATMOS-1 and ATMOS-2 trials assessed efficacy and safety of GT when applied once daily for 4 weeks in patients with moderate-to-severe primary axillary hyperhidrosis, who were ≥9 years old. For both coprimary endpoints of the double-blind trials, difference favouring GT occurred as early as week 1, with continued improvement through week 4. At week 4, significantly more GT-treated patients achieved ASDO/ASDD-C item 2 response (≥4-point improvement from baseline) compared with vehicle (59.5% vs 27.6%; P<0.001).

Patients who completed week 4 of the double-blind trials with ≥80% compliance could receive GT in an open-label extension (ARIDO) for up to an additional 44 weeks. GT-treated patients had significantly greater median reductions in gravimetrically measured sweat production compared with vehicle (P<0.001 at week 4).

From baseline of the double-blind trials to week 44 in the open-label extension, sweat production decreased by 71.3%, which was maintained from a similar decrease of 74.3% in GT-treated patients after 4 weeks of treatment in the double-blind trials.

  1. Glaser DA, et al. Short- and long-term efficacy and safety of glycopyrronium cloth for the treatment of primary axillary hyperhidrosis. Poster presented at the World Congress of Dermatology 2019, 10-15 June, Milan, Italy.

The content and interpretation of these conference highlights are the views and comments of the speakers/authors.