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Dermira and Qbrexza

The company Dermira has come out with a new medicated wipe called Qbrexza that may reform axillary hyperhidrosis treatment. Read on to find out what it is, how it works, and whether it is the right product for you.
Dermira and Qbrexza

Hyperhidrosis, a condition in which the body produces sweat in excess of what is needed to maintain homeostasis of thermoregulation, is often underdiagnosed and undertreated. It is estimated that it affects about 3% of the US population, and even higher proportions of the populations in some other countries. While there are various treatment options available, they are often time consuming and expensive.[1] That is why it is so important that future treatments and research for hyperhidrosis is being conducted. Currently, anticholinergic medications, like glycopyrrolate and oxybutynin, are treatment options for heavy sweaters, but until recently they were not available in a topical form that was effective in treating hyperhidrosis. When taken orally, anticholinergic medications can have systemic side effects that often deter patients from sticking with their treatment.[1] Qbrexa is a notable product because it allows patients to use anticholinergic medication, which are effective at preventing sweat production, without exposing them to as many side effects because it is a localized treatment.

Qbrexza: What It Is and How It Works

Qbrexza is the newest product approved by the FDA to treat primary axillary hyperhidrosis. It is a medicated cloth which can be used as a topical treatment to stop the excessive axillary sweating that many people with hyperhidrosis suffer from. According to the company’s website, Qbrexza contains a topical anticholinergic medication called Glycopyrronium Tosylate which is highly effective at inhibiting sweat gland activation, thus blocking sweat production.[2] Qbrexza is simple and easy to use. Each medicated cloth is designated to be used one time on a clean underarm. Qbrexza should only be used to treat axillary sweating as it is not approved for use on other parts of the body. It only needs to be applied once every 24 hours, making it quite convenient.[3]

There have been other treatments for axillary hyperhidrosis approved by the FDA. In 2004 Botox injections were approved and in 2011 the FDA approved a treatment called Miradry. Botox treatment for axillary hyperhidrosis is highly effective, but it needs to be repeated after several months and it can be invasive and expensive.[1] Miradry is a local permanent treatment option for axillary hyperhidrosis, it has been found to be effective but it is also very expensive. The cost of hyperhidrosis is an issue for many patients seeking treatment for their condition, and continues to be a problem as many insurance plans don’t cover options like MiraDry.[1] This makes Qbrexza unique as it provides patients with a treatment option that is effective, noninvasive, and cost effective.

In order to receive FDA approval, Qbrexza has gone through clinical trials, the results of which can be found on Dermira’s website. The results of two of these clinical trials, called ATMOS-1 and ATMOS-2, are what led to the FDA giving Qbrexza approval. The clinical trials were done to test the efficacy and safety of Qbrexza. Both trials tested the change in the amount of sweat production participants produced before and after treatment. Participants were tested by weighing the amount of sweat they produced and by giving them an Axillary Sweating Daily Diary which is a patient-reported outcome tool developed by Dermira under the consultation of the FDA.[2]

Qbrexza may provide relief for many people who would otherwise lack appropriate treatment. While there have been innovations in treatment options for axillary hyperhidrosis over the years, there hasn’t been an easy and effective prescription solution for those with hyperhidrosis.[4] However, there are over-the-counter antiperspirant wipe alternatives that can be obtained without a doctor’s prescription. For example, Carpe has a line of antiperspirant wipes that can be used for both axillary hyperhidrosis and hyperhidrosis that affects other areas of the body.[5] So, for those who want the ease of a medicated wipe, but who don’t have severe hyperhidrosis, that may be a safer option. Hopefully, in the coming years Qbrexza will provide a successful treatment option for those with hyperhidrosis who are either unable to receive other treatments or who haven’t found another treatment option that works.

Who Can Use It?

Qbrexza can be used by hyperhidrosis patients that are over the age of nine.[2] Another fact that makes Qbrexza notable is that it can be used by the pediatric population. Most of the other doctor prescribed treatments options available cannot be safely used by children.[1] More studies are currently being conducted to see how Qbrexza affects children ages nine to sixteen and the results of these studies will be critical to its use in younger patients. At this time, the studies that have been done on patients between the ages of 9 and 16 have shown promising results regarding the drug’s safety.[6] A product that allows a hyperhidrosis patient to experience relief during adolescents may prevent the development of anxiety that is often associated with hyperhidrosis. It is important to note, however, that children can use over-the-counter topical solutions for hyperhidrosis, and these are the first-line treatments for the condition. If children haven’t tried an over-the-counter antiperspirant prior to Qbrexza they may want to try an alternative antiperspirant wipe first, like those made by Carpe, because over-the-counter antiperspirants don’t require a doctor’s prescription and they generally have less side effects.[1] There is currently no information available regarding the use of Qbrexza in pregnancy and while breastfeeding. It is always advisable to avoid medications during pregnancy and breastfeeding unless they are proven to be safe.[2]

Adverse Reactions

There are several potential adverse reactions that are similar to the side effects produced by oral anticholinergics. Adverse reactions from Qbrexza are less likely to occur than those caused by oral medications for hyperhidrosis because the active ingredient is given in a topical form on a localized area of the body. The most common side effects were dry mouth (24.2%), mydriasis (6.8%), oropharyngeal pain (5.7%), headache (5.0%), urinary hesitation (3.5%), vision blurred (3.5%) and several other effects that occurred in less than 3% of patients.[2]

Aside from the known adverse reactions that patients can experience, it is important to understand how Qbrexza can affect people over the long term. One study, that was presented at the Fall Clinical Dermatology Conference in 2017, found that those who used Qbrexza daily for a period of 48 weeks tolerated it well during that time period. Most side effects were related to local skin reactions and those were experienced by about one third of the people in the study. Eight percent of the people in the study dropped out because of severe reactions, so it is important to understand that serious reactions can occur. Transient blurred vision occured in several participants and it can be a particularly bothersome side effect.[7]

Unfortunately, Qbrexza can only be used on the underarms, which leaves some people with hyperhidrosis lacking the ability to use these potentially helpful wipes. Anticholinergics, the type of medication Qbrexza uses, are powerful drugs and they may not be safe for use on certain sensitive areas of the body.[9] It remains to be seen whether approval for use on other areas of the body will eventually be approved.

For hyperhidrosis patients who want the ease of a medicated wipe like Qbrexza, but who do not wish to use prescription strength drugs, there are other options available on the market. Carpe has recently come out with antiperspirant wipes that utilize Aluminum Chlorohydrate as the active ingredient in their wipes.[5] Aluminum Chlorohydrate is commonly used in over-the-counter topical treatments for hyperhidrosis to reduce excessive sweating.[1] Antiperspirant wipes, like those created by Carpe, have been found to be quite effective and and they can be used safely on most parts of the body.[5] This makes them more versatile than wipes that can only be used for axillary sweating. They also don’t require a require a doctor’s prescription which is can be more convenient for those suffering from hyperhidrosis. Here is how Qbrexza compares to Carpe’s antiperspirant wipes and how to tell which product is the right one for you.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
  2. Qbrexza. (2018). Retrieved September 26, 2018, from https://dermira.com/our-medicines/
  3. PATIENT INFORMATION Qbrexza™. (2018). Retrieved September 26, 2018, from http://pi.dermira.com/QbrexzaPPI.pdf
  4. Dermira Provides Launch Readiness Update for QBREXZA(TM) (glycopyrronium) Cloth for Primary Axillary Hyperhidrosis. (2018, September). Dow Jones Institutional News. Retrieved September 26, 2018, from https://www.nasdaq.com/press-release/dermira-initiates-proofofconcept-study-to-evaluate-qbrexza-glycopyrronium-cloth-in-patients-with-20190222-00305
  5. Innovation Counter. (2018). Final Product Profile Carpe Antiperspirant Wipes [Brochure]. North Carolina: Author.
  6. PROVEN SAFETY AND TOLERABILITY WITH ONCE-DAILY USE IN PEDIATRIC PATIENTS. (2019). Retrieved April, 2019, from https://www.qbrexza.com/hcp/pediatric-safety
  7. Innovation Counter. (2018). Final Product Profile Carpe Antiperspirant Wipes [Brochure]. North Carolina: Author.
  8. Glasser, D. A., Herbert, A. A., Nast, A., Werschler, W. P., Shideler, S., Green, L., Pariser, D. M. (2017, October 12). Open-Label Study (ARIDO) Evaluating Long-Term Safety of Topical Glycopyrronium Tosylate (GT) in Patients With Primary Axillary Hyperhidrosis [Scholarly project]. Retrieved February 19, 2019, from https://www.sweathelp.org/pdf/2017 - Glaser - Open-label study (ARIDO) evaluating long-term safety of topical GT.pdf
  9. Qbrexza™ Rx Topical Cloths/Wipes. (n.d.). Retrieved April, 2019, from https://www.sweathelp.org/hyperhidrosis-treatments/qbrexza
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