PURPOSE: To perform a systematic review of desmopressin as a treatment for nocturia in generally healthy adults, with a focus on both benefits and harms.
MATERIALS AND METHODS: After a careful search of the literature, we identified 10 articles with 2191 patients that met our inclusion criteria: parallel group design randomized controlled trials that report information about at least one benefit or harm of desmopressin in patients with nocturia. We evaluated the quality of included trials based on criteria used by the Cochrane collaboration, assessed heterogeneity using the I2 statistic, and performed random effects meta-analysis.
RESULTS: Studies were generally of high quality, although four used an active run-in period to titrate the dose and exclude patients who had adverse effects or were non-responders; they were at high risk of bias. Doses of desmopressin of at least 25 mcg or higher reduced nocturnal voids and increased the duration to first void. A dose of 100 mcg provided just over an hour of additional sleep before the first void compared with placebo and 0.72 fewer voids per night. Higher doses provided no significant increase in benefit. Hyponatremia (RR 5.1) and headache (RR 4.3) were the most common adverse effects, although serious adverse effects were rare.
CONCLUSIONS: Desmopressin appears to offer a modest benefit for the treatment of nocturia in generally healthy adults, with adequate safety. The initial dose should be between 50 and 100 mcg; higher doses should only be used with caution, and a lower initial dose (25 to 50 mcg) is appropriate for elderly patients. All patients should be monitored for the development of hyponatremia, and the drug should be used with caution in patients with chronic lung disease due to the rare occurrence of respiratory failure. Additional well designed, adequately powered studies of one or more years duration are needed.
Written by:
Ebell MH, Radke T, Gardner J. Are you the author?
Dept of Epidemiology and Biostatistics, University of Georgia.
Reference: J Urol. 2014 Apr 1. pii: S0022-5347(14)03183-8.
doi: 10.1016/j.juro.2014.03.095
PubMed Abstract
PMID: 24704009
