Glycopyrronium Sweat Cloths: Four-Week Results and the Longer Follow-Up

Qbrexza is a prescription cloth containing 2.4% glycopyrronium, an anticholinergic medicine for primary underarm hyperhidrosis. Its US label specifies underarm use only.¹ Evidence about that prescription should not be extended to whole-body deodorant wipes or other sweating patterns.

What the inactive cloth comparison showed

The ATMOS-1 and ATMOS-2 trials compared once-daily glycopyrronium with a matching vehicle cloth for four weeks. “Vehicle” means the preparation without the active medicine.²

In the pooled results, 59.5% using glycopyrronium versus 27.6% using vehicle achieved at least a four-point improvement in the daily diary’s sweat-severity item. This is a percentage of participants reaching a response threshold, not a 59.5% reduction in each person’s sweat.²

Measured sweat production also fell: 107.6 mg per five minutes with medicine versus 92.1 mg with vehicle. Both reported comparisons were statistically significant. The large improvement with the inactive cloth is one reason to retain both numbers when judging the treatment’s contribution.²

These trials measured early response during treatment. They cannot establish how someone will fare through years of repeated use or how this cloth compares with injections, a different prescription cream or a procedure.

What “44-week follow-up” included

The ARIDO extension enrolled 564 people who had completed the earlier trials; 226 completed week 44. Follow-up ended for 106 when the sponsor reached its planned safety target. 44 stopped because of treatment-emergent adverse events, equivalent to 8% of the 550-person safety population. Noncompletion therefore had several causes.³

The reported 71.3% median reduction in measured sweat used the original trials’ baseline and the extension’s week-44 or early-termination observation. It is not a full-week-44 result for every entrant.³

Everyone received active medicine, and missing observations were not imputed. Selection of continuing users and loss of participants can overstate benefit or understate adverse effects. Dermira funded the extension. It supports benefit during continued use, with these limitations; it does not establish a permanent effect after stopping.³

Topical treatment can still cause effects elsewhere

In the controlled trials, the US label reports dry mouth in 24.2% with Qbrexza versus 5.6% with vehicle, and dilated pupils in 6.8% versus none. Application to the skin does not rule out effects beyond the underarms.¹

The label directs users to stop and obtain medical advice for new difficulty urinating. For blurred vision, stop, contact the prescriber and avoid driving or hazardous tasks until it clears. Its warnings also address heat illness when sweating is reduced and additive effects with other anticholinergic medicines.¹ Our glycopyrronium-cloth safety guide covers application and disposal.

Decide what would count as useful improvement

The American Academy of Dermatology⁴ advises establishing the type and cause of excessive sweating first. Sweating caused by a medicine or another condition may require a different plan. Treatment aims to reduce interference with daily activities and should fit the affected body area and the person’s preferences.⁴

For an underarm prescription, record a practical starting point: how often you change shirts, avoid a particular fabric or interrupt work to manage wetness. At the review, bring the same observations, any side effects and the number of days you used the cloth. That gives the prescriber something more specific than “a little better.”

Chapter 10’s “The Step-Up Ladder” and “The Step-Up Conversation” in Arms Up connect trial comparisons with your sweating pattern, daily impact and treatment costs. Ask when benefit will be reviewed, which side effects require stopping and what the next option would be if the benefit does not justify continued use.