Gradual tapering of desmopressin leads to better outcome in nocturnal enuresis

Pediatr Int. 2015 Aug;57(4):656-8. doi: 10.1111/ped.12614. Epub 2015 May 27.

Abstract

Background: Although desmopressin therapy is effective in treating polyuric monosymptomatic nocturnal enuresis (MNE), the relatively high rates of recurrence are problematic. To date, the treatment protocol on the discontinuation of oral desmopressin melt (ODM) tablet, MinirinMelt, has not been established. We tested two protocols of tapering ODM when the patients achieved full response on ODM, and compared the treatment outcomes.

Methods: One hundred and fifty-seven polyuric MNE children were newly treated with ODM at the authors' outpatient clinics (Juntendo Nerima Hospital and Musashi-Murayama Hospital). When the patients did not respond to the 8 week ODM therapy, we added another options such as alarm, anti-cholinergics, and imipramine (92 patients; 58.6%). Sixty-five patients (41.4%) achieved full response on ODM alone, and 49 of them accepted gradual tapering of ODM: group B (n = 25), 240 μg ODM per day → 120 μg ODM per day → 120 μg ODM per alternate day → cessation; and group C (n = 24), 240 μg ODM per day → 120 μg ODM per day → 60 μg ODM per day → 60 μg ODM per alternate day → cessation.

Results: Fourteen patients in group B (56%) and four in group C (17%) had relapses of enuresis after the discontinuation of ODM (P = 0.026).

Conclusions: Gradual tapering of ODM therapy in MNE patients leads to better outcome.

Keywords: desmopressin; nocternal enuresis.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Antidiuretic Agents / administration & dosage
  • Child
  • Deamino Arginine Vasopressin / administration & dosage
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Nocturnal Enuresis / drug therapy*
  • Nocturnal Enuresis / physiopathology
  • Outpatients*
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome
  • Urination / drug effects*
  • Urination / physiology

Substances

  • Antidiuretic Agents
  • Deamino Arginine Vasopressin