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J Am Acad Dermatol. 2019 Jan;80(1):128-138.e2. doi: 10.1016/j.jaad.2018.07.002. Epub 2018 Jul 10.

Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials.

Author information

1
Saint Louis University, St. Louis, Missouri. Electronic address: glasermd@slu.edu.
2
UTHealth McGovern Medical School, Houston, Texas.
3
Charité-Universitätsmedizin Berlin, Berlin, Germany.
4
Premier Clinical Research, Spokane, Washington.
5
George Washington University School of Medicine, Washington, DC.
6
Mamelok Consulting, Palo Alto, California.
7
Dermira, Inc, Menlo Park, California.
8
QST Consultations, Allendale, Michigan.
9
Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Virginia.

Abstract

BACKGROUND:

Glycopyrronium tosylate (GT) is a topical anticholinergic developed for once-daily treatment of primary axillary hyperhidrosis.

OBJECTIVE:

Assess the efficacy and safety of GT for primary axillary hyperhidrosis.

METHODS:

ATMOS-1 and ATMOS-2 were replicate randomized, double-blind, vehicle-controlled, 4-week phase 3 trials. Patients were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. Coprimary endpoints were responder rate (≥4-point improvement from baseline) on item 2 (severity of sweating) of the Axillary Sweating Daily Diary (ASDD), which is a newly developed patient-reported outcome measure, and absolute change from baseline in axillary gravimetric sweat production at week 4. Safety evaluation included treatment-emergent adverse events.

RESULTS:

Pooled data, which are consistent with the individual trial results, show that significantly more GT-treated patients achieved an ASDD-Item 2 response than did those treated with vehicle (59.5% vs 27.6%), and they had reduced sweat production from baseline (-107.6 mg/5 min vs -92.1 mg/5 min) at week 4 (P < .001 for both coprimary end points). Most treatment-emergent adverse events were mild or moderate and infrequently led to discontinuation.

LIMITATIONS:

Short trial duration and inherent challenges in gravimetrically assessing sweat production.

CONCLUSIONS:

GT applied topically on a daily basis over 4 weeks reduced the severity of sweating as measured by ASDD-Item 2, reduced sweat production as measured gravimetrically, and was generally well tolerated in patients with primary axillary hyperhidrosis.

KEYWORDS:

DRM04; anticholinergic; axilla; cholinergic receptor; glycopyrronium tosylate; hyperhidrosis; sweat

PMID:
30003988
DOI:
10.1016/j.jaad.2018.07.002
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