Safety and efficacy of glycopyrronium tosylate in patients with primary axillary hyperhidrosis: a systematic review and meta-analysis

Hyperhidrosis affects approximately 4.8% of the US population, impairing quality of life with excessive sweating. Glycopyrronium tosylate (GT), a topical anticholinergic, treats primary axillary hyperhidrosis in adults and pediatric patients. Despite its use, comprehensive evaluation of GT’s long-term safety and efficacy has been lacking. This systematic review and meta-analysis aimed to assess GT’s effectiveness and safety profiles. Following Cochrane and PRISMA guidelines, we conducted a thorough search of electronic databases for clinical trials on GT. Studies underwent quality assessment and data extraction based on predefined criteria. Primary outcomes included changes in the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and Axillary Sweating Daily Diary (ASDD) or its change score (ASDD-C). Secondary outcomes evaluated safety concerns like mydriasis, dry mouth, urinary hesitation, and treatment-emergent adverse events. Our analysis, integrating data from three randomized controlled trials, highlights GT’s efficacy in improving quality of life and reducing sweating severity. Although minor adverse effects were reported, no significant increase in serious adverse events was observed. These findings suggest GT as a promising treatment for primary axillary hyperhidrosis, with benefits outweighing minimal side effects.