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

BackgroundGlycopyrronium tosylate (GT) is a topical anticholinergic approved in the USA for primary axillary hyperhidrosis in patients aged 9years. 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.ObjectiveOur objective was to evaluate patient-reported outcomes (PROs) from these trials.MethodsPatients aged 9years with primary axillary hyperhidrosis 6 months, gravimetrically measured sweat production 50mg/5min 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 4weeks. The 4-item ASDD, 6 Weekly Impact (WI) items, Patient Global Impression of Change (PGIC), HDSS, and Dermatology Life Quality Index (DLQI) were utilized.ResultsIn 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.ConclusionsPRO results demonstrated that GT reduced the disease burden of primary axillary hyperhidrosis.Trial registrationClinicaltrials.gov; ATMOS-1 (NCT02530281), ATMOS-2 (NCT02530294).