NEW YORK (Reuters Health) – In children with neurodisability, glycopyrronium liquid may be a better choice to address drooling than a hyoscine skin patch, according to new research from the UK.
“We concluded that glycopyrronium should be considered the medication first used to treat drooling,” lead author Dr. Jeremy R. Parr of Newcastle University in Newcastle Upon Tyne, told Reuters Health in an email.
“In the UK and many other countries, child health professionals mostly use hyoscine patches rather than glycopyrronium medicine to treat drooling in children with neurodevelopmental disorders, such as cerebral palsy,” he said. “The study showed that the medications were equally effective to treat drooling. However, side effects were more common for hyoscine, and almost half of children stopped the hyoscine patches during treatment.”
Hyoscine’s more bothersome side effects – redness, swelling, blistering, skin breakdown, dry mouth, pupil dilation, unsteady walking, hyperactivity, floppiness, and increased seizure activity – may make children more likely to stop taking it.
Dr. Parr and colleagues randomized 90 children (55 boys) to use a hyoscine skin patch or glycopyrronium liquid (orally or by feeding tube) to control drooling. Via weekly phone calls to parents for 4 weeks, dosages were increased and adjusted to achieve optimum symptom control with minimal side effects; the optimal dose was then maintained until week 12.
The participants, recruited from 15 UK National Health Service neurodevelopmental teams, were ages 3 to 16 years (median, 4) and weighed at least 10 kg. All needed medication to reduce drooling and had no contraindication to either drug, no deteriorating progressive neurological function, and no previous medical or surgical treatments for drooling.
The most common diagnoses were cerebral palsy and developmental delay/disorder (each in 25% of the participants); three-quarters had multiple diagnoses (up to 7 per child). Two-thirds of the children were taking one or more medications.
Of 85 children who began treatment, 47 received hyoscine and 38 glycopyrronium. Baseline mean Drooling Impact Scale (DIS) scores were similar in the two groups (hyoscine 57.9; glycopyrronium, 52.1).
Both drugs significantly reduced mean DIS scores at week 4: by 25.0 points for hyoscine and by 26.6 for glycopyrronium, a similar degree of improvement.
At 4 weeks and 12 weeks, however, the hyoscine recipients were less likely to still be taking their medication. At 12 weeks, rates of ongoing use were 55% in the hyoscine group and 82% in the glycopyrronium group. Overall, glycopyrronium users were 42% more likely than hyoscine users to persist with treatment at 12 weeks.
“Most UK paediatricians prescribe hyoscine first and glycopyrronium second. There is no comparative evidence about the effectiveness, side effects or patient acceptability of these medications,” the authors write. “Where either medication might be used, glycopyrronium should be the medication of first choice – the opposite situation to current UK prescribing practice.”
Looking ahead, Dr. Parr told Reuters Health, “In the future, we aim to show whether a stepped plan of how to start and increase the medications, and monitor side effects, would be useful for clinicians and lead to more-effective treatment for children.”
SOURCE: http://bit.ly/2pKJgD4
Arch Dis Child 2017.
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