Glycopyrronium bromide (GPB) cream can be used as an option to treat severe primary axillary hyperhidrosis in adults, if lifestyle advice, topical aluminium-based antiperspirants and oral antimuscarinics:
have not controlled underarm sweating, or
are contraindicated or not tolerated.
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.
GPB cream must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. GPB cream must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that GPB cream provides benefits and value for money, so it can be used routinely in the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
Initial treatment for severe primary axillary hyperhidrosis is lifestyle advice and topical aluminium-based antiperspirants. If these do not work or are not suitable, usual treatment includes oral antimuscarinics. Botulinum toxin type A (botulinum toxin) is sometimes available in secondary care.
For this evaluation, the company asked for GPB cream to be considered only after lifestyle advice and topical aluminium-based antiperspirants, as an alternative to oral antimuscarinics or botulinum toxin. 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 a better quality of life than people using a placebo. GPB cream has not been directly compared in a clinical trial with oral antimuscarinics or botulinum toxin, but indirect comparisons suggest it may not be as effective.
Although GPB cream may not be as effective as some usual treatments including botulinum toxin, it is less costly. The cost-effectiveness estimates for GPB cream are within the range that NICE considers an acceptable use of NHS resources only when compared with botulinum toxin. So, GPB cream can be used but only when lifestyle advice, topical aluminium-based antiperspirants and oral antimuscarinics have not controlled underarm sweating, or are contraindicated or not tolerated.