Desmopressin 120 mcg, 180 mcg, 240 mcg: The right treatment for the right patient

Abstract

Background: The first-line drug therapy for patients with nocturnal enuresis (NE) associated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP). Objective: To evaluate if increasing dose of oral desmopressin lyophilisate (MELT) can improve response rates to dDAVP and is useful in enuretic children. Materials and methods: We enrolled a total of 260 children all diagnosed with NE. Enuretic children were treated with increasing MELT at a dose of 120, 180 and 240 mcg a day. Results. We included in our study a total of 237 children, 164 males (69.2%) and 73 females (30.8%) aged between 5 and 18 years (mean age 10.32 ± 2.52 years). Of the 237 patients enrolled in the study and treated with MELT 120 mcg, a full response was achieved in 135 (56.9%). A partial response was achieved in 21 (8.9%) patients, therefore the dose was increased up to 180 mcg, with further improving symptoms (14.3%) or full response (9.5%), and up to 240 mcg, without usefulness. Conclusions: MELT at the dose of 120 mcg resulted efficacy and safety; the increased dose up to 180 mcg resulted poorly efficacy; finally, the further increase up to 240 mcg did not improve the symptoms with the increased risk of side effects.KEY WORDS: Desmopressin; Nocturnal enuresis. ated with nocturnal polyuria and normal bladder function is desmopressin (dDAVP) for a period of 3 months following by withdrawal. dDAVP is associated with a response rate of about 40-60%, however its effect may not be maintained on discontinuing treatment, and symptoms have been found to recur in about 50-80% after stopping treatment (3). The different formulations of dDAVP are an intranasal solution, an oral tablet formulation and the recent oral sublingual lyophilisate (MELT). The aim of this study is to evaluate if increasing dose of MELT (120, 180, 240 mcg/day) can improve response rates to dDAVP in enuretic children. MATERIALS AND METHODSWe enrolled a total of 260 children all diagnosed with NE, between April 2014 and April 2017, at the Paediatric Service of Campus Bio-Medico Hospital in Rome. Inclusion criteria were: age > 5 years and a diagnosis of primary MNE (PMNE) without NE treatment in the last 3 months. Exclusion criteria were the presence of secondary NE, any provided story of urinary infection, nephrogenic diabetes or congenital genitourinary anomalies. The children and their families were asked to participate in the study. This study was conducted in accordance with the regulatory standards of Good Clinical Practice and the Declaration of Helsinki. We carefully evaluated each patients with medical history and physical examination, including monitoring blood pressure, possible sign of spinal dysraphism or polythelia, neurological reflexes and genital examination. During the period of treatment, all patients and their parents were asked to keep a NE calendar depicting the wet and the dry nights and in addition, we educated both child and parents with dietary advices (4). During the follow-up, families were called to verify their adherence and respons...

Non‐dipping phenomenon effects in monosymptomatic nocturnal enuresis treatment?

“…Our study results become more significant considering that side effects as serious as central pontine myelinosis may occur due to hyponatremia linked to desmopressin, frequently used as a standard treatment. 20,21 However, our study was performed with a limited number of patients in a single center and should be supported by studies with higher patient numbers.…”

Better outcomes with desmopressin melt than enuretic alarm therapy in children with nocturnal enuresis during coronavirus disease 2019 (COVID-19)

“…The melt formulation, which has been used since 2005, has increased efficacy compared to its previous forms, maintains a more stable plasma concentration, and features a low side effect profile. [ 21 , 22 ] Another common treatment method is enuresis alarms. Linen et al compared enuresis alarms and desmopressin melt and reported similar efficacies (68.2% vs. 68.4%).…”

“…Desmopressin is the most common pharmacological agent used to treat NE. The melt formulation, which has been used since 2005, has increased efficacy compared to its previous forms, maintains a more stable plasma concentration, and features a low side effect profile [21,22] . Another common treatment method is enuresis alarms.…”

Primer Enurezis Nocturna Tanılı Hastalarda En Zor Sorular:Doğru tedavi? Doğru süre?

“…Ebeveynlerinin en az biri okuryazar olmayan hasta sayısı ise 28 (%18,90) idi. 15,16 . Tedavi cevabı hızlı olan bir molekül olmasına rağmen desmopressin tedavisi kesildiği zaman yüksek nüks oranları görülmesi istenmeyen bir durumdur.…”