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  • Question on Consultation

    Has all of the relevant evidence been taken into account?

  • Question on Consultation

    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

  • Question on Consultation

    Are the recommendations sound and a suitable basis for guidance to the NHS?

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    Are there any aspects of the recommendations that need particular consideration to ensure we avoid unlawful discrimination against any group of people on the grounds of age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex or sexual orientation?

1 Recommendations

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1 Recommendations

1.1

Glycopyrronium bromide (GPB) cream should not be used to treat severe primary axillary hyperhidrosis in adults.

1.2

This recommendation is not intended to affect treatment with GPB cream that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

GPB cream is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.

This is because the available evidence does not suggest that GPB cream is value for money in this population.

Why the committee made these recommendations

Usual treatment for severe primary axillary hyperhidrosis is lifestyle advice and topical aluminium-based antiperspirants. If these do not work or are not suitable, then people may have oral anticholinergics. In some geographical locations, botulinum toxin type A (botulinum toxin) is available.

For this evaluation, the company asked for GPB cream to be considered only after lifestyle advice and topical aluminium-based antiperspirants. This does not include everyone who it is licensed for.

Clinical trial evidence shows that people who use GPB cream have less underarm sweat and may have better quality of life than people using a placebo. GPB cream has not been directly compared in a clinical trial with oral anticholinergics or botulinum toxin, but indirect comparisons suggest it may not be as effective as those treatments.

The cost effectiveness estimates are outside of the range that NICE considers an acceptable use of resources. So GPB cream should not be used.