Inhaled glycopyrronium on excessive sialorrhea and drooling

Objective: The primary objective is to investigate the safety and tolerability of inhalation of glycopyrronium inhalation powder using different dosing regimens. The second objectives are to determine the decrease in drooling by using different dosing regimens of glycopyrronium inhalation powder and to investigate the preferred method of treatment by patients.

Study design: A 5-week dose finding study to determine the optimal dose for glycopyrronium inhalation use in PD patients suffering from sialorrhea.

Study population: Patients, age 18 or older, diagnosed with Parkinson’s disease with moderate to severe sialorrhea.
Intervention: Following a baseline week, each participant will use glycopyrronium inhalations during four weeks. Every week the dosing regimen change: starting with one time daily inhalation of 44 µg glycopyrronium, followed by two time daily inhalation of 44 µg glycopyrronium, then a three time daily inhalation of 44 µg glycopyrronium, and during week 4 participants can use glycopyrronium on demand (zero to four times a day).

Main study parameters/endpoints: The primary endpoint is the determination of the safety and tolerability of glycopyrronium inhalations in PD patients with sialorrhea. The secondary endpoints are to determine mean difference in loss of saliva between dosing regimens and baseline week and to investigate the preferred method of treatment by patients.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Drooling can have a major impact on parkinsonian patients. The current standard-of-care oral solution of glycopyrronium is suboptimal for some patients. Therefore research is needed in this population.

Glycopyrronium solution is used in patients suffering from sialorrhea and Parkinson Disease. The solution isn't sufficient enough for all patients due to to much effect or no effect at all. Glycopyrronium inhalation powder is used in patients with COPD, a common side effect is dry mouth. This gives us the hypothesis that it can be used in patients suffering from sialorrhea.

T0: Inclusion
T1: week with once daily use of glycopyrronium

T2: week with twice daily use of glycopyrronium

T3: week with three times a day use of glycopyrronium

T4: week with ondemand use of glycopyrronium with a maximum of 4.

The participant will use 4 different dosing regimes of glycopyrronium inhalation powder. Three times a day a drooling score must be filled. Patients must record adverse events and other special events that occur during the use of the inhalation powder. after the 3rd week of treatment a patient preference questionaire must be answered.