|The following article is part of conference coverage from the 2018 Fall Clinical Dermatology Conference in Las Vegas, Nevada.Dermatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in dermatology. Check back for the latest news from Fall Clinical Derm 2018.|
After a long 12-year drought, patients with hyperhidrosis finally have a new focal treatment to consider. The approval and market availability of glycopyrronium tosylate cloth (Qbrexza™; Dermira) earlier this month allows patients as young as 9 to effectively treat axillary hyperhidrosis with a single-use cloth, which will reportedly cost patients anywhere from $35 to $70 for a 30-day supply based on insurance coverage.
Updates on the drug’s application in clinical practice, as well as information on other promising treatments currently under investigation, were the focus of a plenary presentation at the Fall Clinical Dermatology Conference, taking place October 18-21, 2018 in Las Vegas, Nevada. The session was led by key hyperhidrosis researchers David Pariser, MD, FAAD, FACP, professor of dermatology at Eastern Virginia Medical School in Norfolk, and president of the International Hyperhidrosis Society, and Dee Anna Glaser, MD, professor and chair of dermatology at the Saint Louis University School of Medicine in Missouri.
Dr Pariser reported that newer studies have shown a prevalence of hyperhidrosis as high as 4.8% in the United States, which is comparable to the prevalence of psoriasis. Notably, 17% of teens report excessive sweating, he said, although that figure does not account for diagnosed cases of hyperhidrosis.
In discussing currently available treatments and solutions, Dr Pariser pointed to the new trend in over-the-counter antiperspirants, with many brands now offering a “clinical strength” product containing aluminum zirconium tetrachlorohydrex, which forms a colloidal plug over the sweat gland that gradually breaks down over time. These products are best applied overnight, he said, noting that some products may be suitable to control excessive sweating in other body areas besides the axilla.
As for glycopyrronium, Dr Pariser noted that patients in the clinical trial (N=350, ATMOS-1 and ATMOS-2) reported improvements in symptoms as early as a few days after treatment initiation, with most seeing a significant reduction in sweat production 2-3 weeks after beginning treatment (52.8% reduction in sweat production over 4 weeks). The most common adverse events were dry mouth and mydriasis, which most likely was due to patients not thoroughly washing their hands after application and touching their eyes.
Safety was maintained for 1 year after treatment initiation, and the safety profile was consistent with other anticholinergic treatments. Notably, the drug was equally as effective in pediatric patients.
Two additional treatments which are still being investigated are sofpironium bromide gel, known as a “soft drug” which is rapidly metabolized and thus less is absorbed into the bloodstream. Dr Pariser recalled results from a recent phase 2 dose-finding study in 227 patients, in which a 70% and 75.9% reduction in sweat production was noted for the 5% and 15% formulations.
Overall, the drug was well-tolerated with similar treatment-emergent adverse events as glycopyrronium. Also currently being studied is oxybutynin 7.5 mg plus pilocarpine 7.5 mg, a combination of an immediate and delayed-release drug that is intended to help reduce dry mouth. Recent study results have shown a significant decrease in sweating and fewer reports of dry mouth from study participants, showing promise.
Dr Pariser was joined by Dr Glaser, who better explained how currently available treatments can be applied in the clinic. Noting that most patients with hyperhidrosis present with multiple affected body areas, she emphasized that it is important to have a plan that addresses all affected sites.
“Focal treatment is the best treatment if you can do that,” she said, “compared with systemic therapy, where you have a greater risk of having systemic side effects.” With that, she noted that it is important to set patient expectations appropriately, and to use the Hyperhidrosis Disease Severity Scale questionnaire to help identify which body area is most bothersome to the patient so you know which area to prioritize.
Dr Glaser expressed excitement over the availability of glycopyrronium cloth, especially for the pediatric population. She reviewed safe usage, explaining that the treatment only requires patients to apply the cloth with 1 swipe under each underarm nightly, followed by a thorough handwashing. She noted that patients may continue to use antiperspirant and/or deodorant with the treatment, and it is safe to use alongside other focal therapies, but not systemic ones. She even suggested that the cloths may be helpful for patients who also experience excessive palm sweating, though there is no available evidence that supports that usage.
Overall, recent drug approvals and investigational therapies in the pipeline should provide a boost of confidence to clinicians who now have more options to personalize treatment based on the specific needs of their patients.
Disclosures: Both presenters reported several relationships with industry. Please see the conference program for a full list author disclosures.
For more coverage of Fall Clinical Derm 2018, click here.
Pariser DM, Glaser DA. New therapies for hyperhidrosis. Presented at: 2018 Fall Clinical Dermatology Conference. October 18-21, 2018; Las Vegas, NV.