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Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability

Lookup NU author(s): Professor Jeremy Parr, Dr Emma Todhunter, Dr Lindsay Pennington, Dr Deborah Stocken, Dr Jill Cadwgan, Mike Cole, Emeritus Professor Allan Colver

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Objective Investigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability.Design Multicentre, single-blind, randomised controlled trial.Setting Recruitment through neurodisability teams; treatment by parents.Participants Ninety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management.Intervention Children were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks.Primary and secondary outcomes Primary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment.Results Both medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95).Conclusions Hyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation.


Publication metadata

Author(s): Parr JR, Todhunter E, Pennington L, Stocken D, Cadwgan J, O'Hare AE, Tuffrey C, Williams J, Cole M, Colver AF

Publication type: Article

Publication status: Published

Journal: Archives of of Disease in Childhood

Year: 2017

Print publication date: 09/12/2017

Online publication date: 30/11/2017

Acceptance date: 02/10/2017

Date deposited: 12/12/2017

ISSN (print): 0003-9888

ISSN (electronic): 1468-2044

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/archdischild-2017-313763

DOI: 10.1136/archdischild-2017-313763


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