Clinical Question

Is desmopressin safe and effective in treating adults with nocturia?

Bottom Line

Desmopressin is a safe and effective treatment to offer adults with clinically significant nocturia. The initial starting dose should be 50 to 100 mcg, with lower dosing for the advanced older patient. All patients should be monitored for hyponatremia. (Level of Evidence = 1a)

Synopsis

These investigators searched PubMed and reference lists of included studies, as well as a previous systematic review, for randomized clinical trials that compared desmopressin with placebo in adults with nocturia. Two reviewers independently assessed potential publications for inclusion and methodologic quality, and differences were resolved after a consensus discussion with a third reviewer. Quality was assessed using the standard Cochrane Collaboration bias risk guidelines. Ten articles (N = 2,191) met inclusion criteria, including four studies that used an active run-in period after which patients who experienced adverse events or did not respond to the study drug were excluded. As a result, these four studies were considered at high risk of bias, whereas the remaining six were all assessed as high quality. Outcomes were stratified by dose (less than 100 mcg vs. 100 mcg or greater).

Overall, patients receiving desmopressin experienced a significant decrease in the number of nocturnal voids compared with those taking placebo (0.5 fewer voids; 95% confidence interval, 0.35 to 0.65). The benefit was greater for doses of 100 mcg or higher than for lower doses (0.77 fewer voids vs. 0.3 fewer voids, respectively). The overall results were also homogeneous in the high-dose subgroup. In addition, patients receiving desmopressin experienced significantly increased sleep time compared with control patients (mean = 58 more minutes; 95% confidence interval, 39 to 76). Headaches and hyponatremia were the most commonly reported adverse effects; complications and severe adverse events were rare. There were no differences in results based on sex.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: EbellMHRadkeTGardnerJA systematic review of the efficacy and safety of desmopressin for nocturia in adults. J Urol2014; 192( 3): 829– 835.