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Journal of Biological Regulators and... 2019Nocturnal enuresis (NE) was defined by the World Health Organization (ICD-10) and the American Psychiatric Association (DSM-5) as bed-wetting in children aged >5 years.... (Review)
Review
Nocturnal enuresis (NE) was defined by the World Health Organization (ICD-10) and the American Psychiatric Association (DSM-5) as bed-wetting in children aged >5 years. In cases of mental retardation, the developmental age may be equivalent to 5 years. In this review, we focus on the current knowledge about the etiology of enuresis and the most recent therapeutical options. Both non-pharmacological and pharmacological therapies are included, although the relative effectiveness of each remains uncertain. To date, motivational, alarm and drug therapies are the mainstay of treatment. Alarm therapy remains the first-line treatment modality for NE, while desmopressin is the most commonly used medical treatment.
Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis
PubMed: 31630713
DOI: No ID Found -
European Journal of Clinical... Jun 2022This review aims to provide prescribing clinicians a deeper appreciation of desmopressin's clinical indications and formulation types, to better balance efficacy and... (Review)
Review
PURPOSE
This review aims to provide prescribing clinicians a deeper appreciation of desmopressin's clinical indications and formulation types, to better balance efficacy and safety through proper formulation selection.
BACKGROUND
Since its discovery 50 years ago, desmopressin's antidiuretic properties have been used for central diabetes insipidus, primary monosymptomatic nocturnal enuresis and adult nocturnal polyuria, while its coagulant effects are useful for mild hemophilia A and von Willebrand Disease. During this time, newer formulations of desmopressin have also been introduced to the market raising questions on interchangeability, dose conversion and safety. The wide array of clinical indications and variable pharmacokinetic properties of different desmopressin preparations raises the possibility of medication error, especially the risk of hyponatraemia.
METHODOLOGY
A narrative review to explore clinically relevant aspects of desmopressin therapy, synthesising information obtained from searches of published literature.
RESULTS
We identified that the risk factors for developing hyponatremia include extremes of age, existing comorbidity, drug interaction, intranasal formulations and intercurrent illness. We describe the dose equivalence between all formulations to facilitate conversion. We highlight that in view of inter-subject variability, close monitoring is recommended when switching preparations. We found that paediatric data remains limited, leading to recent proposals for age- and weight-based dosing regimens.
CONCLUSION
The risk of hyponatremia, albeit small, can be reduced by adhering to the indication-specific doses and taking steps to govern the safe prescription of the drug. Further paediatric clinical trials are awaited to expand the evidence base of childhood desmopressin therapy.
Topics: Administration, Intranasal; Administration, Oral; Adult; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Humans; Hyponatremia
PubMed: 35199198
DOI: 10.1007/s00228-022-03297-z -
Expert Opinion on Pharmacotherapy Feb 2018Nocturia is a common urinary condition experienced by both men and women. While desmopressin has historically been utilized to treat conditions such as central diabetes... (Review)
Review
Nocturia is a common urinary condition experienced by both men and women. While desmopressin has historically been utilized to treat conditions such as central diabetes insipidus and primary nocturnal enuresis, there is an increased interest in the use of desmopressin in the management of adult nocturia. Areas covered: This article provides a review on the pathophysiology of nocturia and the clinical outcomes and safety profile of desmopressin in the management of adult nocturnal voiding dysfunction. Expert opinion: To date, desmopressin is the only anti-diuretic hormone that is approved for nocturia. Published literature on desmopressin demonstrate good clinical efficacy in terms of number of nocturnal voids, voided volume and sleep period. Newer formulations have shown that a minimum dosage of 25 μg orally disintegrating sublingual desmopressin appears to be ideal for women, whereas men usually benefit from a minimum of 50 μg. Of the known adverse drug reactions, hyponatremia remains a major concern especially in patients over 65 years of age. At present, long term data on desmopressin remains scarce. Lastly, it is important to stress that no single treatment deals with nocturia in all contexts, and careful assessment remains essential to identify the appropriate and safest treatment in each patient.
Topics: Antidiuretic Agents; Aquaporins; Clinical Trials as Topic; Deamino Arginine Vasopressin; Government Regulation; Humans; Hyponatremia; Nocturia; Treatment Outcome
PubMed: 29376448
DOI: 10.1080/14656566.2018.1429406 -
Best Practice & Research. Clinical... Mar 2016Diabetes insipidus (DI) in pregnancy is a heterogeneous syndrome, most classically presenting with polyuria and polydipsia that can complicate approximately 1 in 30,000... (Review)
Review
Diabetes insipidus (DI) in pregnancy is a heterogeneous syndrome, most classically presenting with polyuria and polydipsia that can complicate approximately 1 in 30,000 pregnancies. The presentation can involve exacerbation of central or nephrogenic DI during pregnancy, which may have been either overt or subclinical prior to pregnancy. Women without preexisting DI can also be affected by the actions of placental vasopressinase which increases in activity between the 4th and 38th weeks of gestation, leading to accelerated metabolism of AVP and causing a transient form of DI of pregnancy. This type of DI may be associated with certain complications during pregnancy and delivery, such as preeclampsia. Management of DI of pregnancy depends on the pathophysiology of the disease; forms of DI that lack AVP can be treated with desmopressin (DDAVP), while forms of DI that involve resistance to AVP require evaluation of the underlying causes.
Topics: Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Pregnancy; Pregnancy Complications
PubMed: 27156766
DOI: 10.1016/j.beem.2016.02.005 -
The American Journal of Medicine Jun 2018
Topics: Deamino Arginine Vasopressin; Humans; Hyponatremia
PubMed: 29784206
DOI: 10.1016/j.amjmed.2018.01.016 -
European Urology Focus Mar 2021Nocturia is a prevalent symptom with varied aetiology and no consensus on treatment options. (Review)
Review
CONTEXT
Nocturia is a prevalent symptom with varied aetiology and no consensus on treatment options.
OBJECTIVE
We systematically reviewed evidence comparing the benefits and harms of various treatment options for nocturia or nocturnal incontinence in women.
EVIDENCE ACQUISITION
Literature search was performed using Embase, Medline, and Cochrane databases (from 1 January 1946 to 26 September 2017), following the methods detailed in the Cochrane Handbook. The protocol was registered with PROSPERO. Certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
EVIDENCE SYNTHESIS
The literature search identified 3573 citations, of which 11 full-text articles were included. Three studies on desmopressin and four on antimuscarinics provided evidence of improving nocturia symptoms. Four studies on behavioural treatment provided limited evidence and controversial results. One study on oestrogen did not prove the benefit of any mode of administration, and one small study on functional magnetic stimulation provided some evidence of effectiveness in nocturia. One randomised controlled trial (RCT; 141 participants) reported a statistically significant difference between the desmopressin and placebo groups (desmopressin patients experienced 0.75 [95% confidence interval {CI} 0.47-1.03] nocturia episodes less than those experience by the placebo group; certainty of evidence = low). The only RCT on antimuscarinics in women with nocturia reported that oxybutynin reduced the number of nocturia episodes by 0.3 (95% CI -0.02 to 0.62) versus placebo. In one RCT comparing tolterodine with the combination of tolterodine with behavioural therapy, there was significant change from baseline nocturnal incontinence episodes in both groups.
CONCLUSIONS
There is some evidence that desmopressin and antimuscarinics are effective treatment options for nocturia; however, there is very limited evidence for other treatment options. The findings should be interpreted with caution as there were some methodological flaws in the included studies, particularly outcome heterogeneity.
PATIENT SUMMARY
This review identified several medical treatments for nocturia in women, such as desmopressin and antimuscarinics, which appear to improve the severity of the condition.
Topics: Adult; Deamino Arginine Vasopressin; Female; Humans; Middle Aged; Muscarinic Antagonists; Nocturia; Randomized Controlled Trials as Topic; Tolterodine Tartrate
PubMed: 32061540
DOI: 10.1016/j.euf.2020.01.012 -
BJU International Mar 2019To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent (AA) therapy in the management of paediatric... (Review)
Review
Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis.
OBJECTIVE
To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent (AA) therapy in the management of paediatric monosymptomatic nocturnal enuresis (MNE) using a network meta-analysis.
MATERIALS AND METHODS
We searched the electronic databases PubMed, Cochrane Library, EMBASE and Web of Science from inception to 1 March 2018. Randomized controlled trials (RCTs) that compared desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AAs were identified. The network meta-analysis was conducted with software R 3.3.2 and STATA 14.0.
RESULTS
Eighteen RCTs with a total of 1 649 participants were included. The meta-analysis results showed that complete response (CR) and success rates with desmopressin plus AAs were higher than with desmopressin or alarm monotherapy. Success rates for desmopressin plus alarm therapy were higher than for alarm monotherapy. No obvious difference was observed between desmopressin plus AAs and desmopressin plus alarm therapy with regard to CR rate and success rate. The relapse rate with alarm monotherapy was much lower than with desmopressin monotherapy. Adverse events seemed to be infrequently and tolerable for all treatments. The ranking probability results were as follows: desmopressin plus AA ranked first for the outcomes of CR and success, desmopressin plus alarm therapy ranked first for mean number of wet nights per week, and alarm therapy had the lowest relapse rate.
CONCLUSIONS
The network meta-analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AAwere associated with tolerable adverse events; however, additional high-quality studies are needed for further evaluation of these treatments.
Topics: Antidiuretic Agents; Child; Cholinergic Antagonists; Clinical Alarms; Deamino Arginine Vasopressin; Humans; Network Meta-Analysis; Nocturnal Enuresis; Randomized Controlled Trials as Topic; Recurrence; Treatment Outcome
PubMed: 30216627
DOI: 10.1111/bju.14539 -
International Journal of Clinical... Nov 2017To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways. (Review)
Review
AIM
To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways.
METHODS
A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences.
RESULTS
Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management.
CONCLUSIONS
The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.
Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Life Style; Nocturia; Polyuria; Quality of Life
PubMed: 28984060
DOI: 10.1111/ijcp.13027 -
The Medical Letter on Drugs and... Mar 2019
Review
Topics: Administration, Sublingual; Animals; Antidiuretic Agents; Deamino Arginine Vasopressin; Drug Costs; Humans; Nasal Sprays; Polyuria; Randomized Controlled Trials as Topic
PubMed: 31022158
DOI: No ID Found -
Expert Review of Clinical Pharmacology Dec 2017Nocturia impacts 70% of individuals over age 70 years. Nocturnal polyuria is present in up to 88% of adults with nocturia, however, treatment options for reducing... (Review)
Review
Nocturia impacts 70% of individuals over age 70 years. Nocturnal polyuria is present in up to 88% of adults with nocturia, however, treatment options for reducing nighttime urine production have historically been limited to behavioral modification and off label use of timed diuretics and desmopressin. Noctiva (desmopressin acetate nasal spray, DANS, Serenity Pharmaceuticals, LLC) is a novel formulation of desmopressin approved by the Food and Drug Administration for the treatment of nocturia due to nocturnal polyuria in March 2017. Areas covered: Incidence and etiology of nocturia, currently available therapies (approved and off label), and pharmacokinetic, efficacy, and safety data associated with DANS. Expert commentary: DANS has been studied for the treatment of nocturia in adults over age 50 without contraindications to the use of desmopressin. 49% receiving the higher clinical dose experienced ≥50% reduction in nocturnal voids in clinical trials vs. 30% with placebo. Although nadir serum sodium <135 mmol/L was not uncommon (14%), the incidence of sodium ≤125 mmol/L was rare (1%). DANS therefore appears to benefit a significant subset of patients with nocturia while maintaining an acceptable risk profile. Given the risks of hyponatremia, education of patients and prescribers in contraindications and the importance of monitoring are paramount.
Topics: Adult; Aged; Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Hyponatremia; Incidence; Middle Aged; Nasal Sprays; Nocturia; Off-Label Use
PubMed: 29048257
DOI: 10.1080/17512433.2017.1394185