Effectiveness of oxybutynin for treatment of hyperhidrosis in overweight and obese patients

Wolosker, Nelson; Krutman, Mariana; Kauffman, Paulo; Paula, Rafael P. de; Campos, João V.; Puech-Leão, Pedro

doi:10.1016/j.ramb.2012.11.002

Cited by 33 publications

(17 citation statements)

References 19 publications

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“…Randomized controlled trials confirmed that improvement in symptoms following oxybutynin therapy was significant compared with placebo . This improvement was demonstrated by both objective measurements and patient questionnaire assessments . Oxybutynin therapy does not demonstrate tachyphylaxis and patients continued to note symptom improvement in long‐term studies .…”

Section: Resultsmentioning

confidence: 81%

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review

Cruddas

Baker

2017

Acad Dermatol Venereol

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Primary hyperhidrosis is a condition characterized by excessive sweating. Patients are treated off-license with oral anticholinergic medications and report adverse events associated with systemic anticholinergic interactions. This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis. PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946 to 2015. Inclusion criteria included observational and experimental studies, anticholinergic medication use in primary hyperhidrosis, oral therapy and clear diagnostic and outcome measures. Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/day, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies, a mean of 10.9% of total participants ceased treatment due to dry mouth. Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events.

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Section: Resultsmentioning

confidence: 81%

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review

Cruddas

Baker

2017

Acad Dermatol Venereol

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“…41 Nor overweight or obesity was considered limiting factors for treatment, as 67.8% of patients with overweight and 63% obese showed significant clinical improvement. 42 When patients over 40 years were analyzed, 48 subjects between 40-49 years and 39 patients older than 50 years had significant improvement (75% in the first group and 87.2% in the second), with emphasis to the fact that most of the older patients had a high level of improvement. 43 At the other extreme, 45 children aged 7 to 14 years with palmar hyperhidrosis were evaluated, and over 85% showed improvement.…”

Section: Resultsmentioning

confidence: 99%

Oxybutynin as an alternative treatment for hyperhidrosis

Delort

Marchi

Corrêa

2017

An. Bras. Dermatol.

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Hyperhidrosis is the excessive production of sweating, which can be primary and focal or secondary to various pathologies. The exact cause of primary focal hyperhidrosis is still unknown, although a genetic basis is recognized, and its prevalence varies from 1% to 2.8%. The most affected sites are the armpits, palms, soles and face. It causes much discomfort, affects the quality of life, and is estimated to be undervalued by health professionals. Many treatment options are proposed, both clinical and surgical. The aim of this review is to focus on the treatment of hyperhidrosis with oxybutynin, an anticholinergic drug originally used to control overactive bladder.

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“…Seventeen studies, including the validation work, had a surgical intervention, 234,236,238-252 13 dermatology studies 55,57,60,[62][63][64][65][66][67]237,[253][254][255] and one quality-of-life review. 227 The tool was used in Austria (n = 6 [240][241][242]248,249,251 ), Brazil (n = 21 57,[60][61][62][63][64][65][66][67]234,[236][237][238][239]243,244,246,247,[252][253][254][255] ), Germany (n = 1 The survey response rate was 91% (344 patients). Patients included in the study suffered with either palmar and plantar (57.4%), palmar, axillary and plantar (25%), axillary (15.7%) or facial (6.5%) sweating.…”

Section: Hyperhidrosis Quality-of-life Questionnairementioning

confidence: 99%

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Effectiveness of oxybutynin for treatment of hyperhidrosis in overweight and obese patients

Abstract: Overweight and obese patients with palmar or axillary hyperhidrosis present significant improvement in QOL after treatment with oxybutynin, and the results are comparable to those of normal weight individuals.

Cited by 33 publications

References 19 publications

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review

Oxybutynin as an alternative treatment for hyperhidrosis

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

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