title: Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Swedish Enuresis Trial Group.
abstract: The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long-term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4-wk observation period, a 6-wk dose titration period (with 20-40 microg desmopressin) and a 1-y, long-term treatment period. A treatment-free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6-12 y with PMNE were recruited. Of these, 245 patients (61%) experienced > or = 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long-term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3-7.0) during the observation period to a median of 0.8 (range 0.0-5.0) during the last 3-mo period. Seventy-seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6-7-y-olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug-related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long-term treatment of PMNE, with a significant therapeutic effect also in children of 6-7 y of age.
authors.affiliation: Program for Nephrology and Urology, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Tullus
authors.forename: R
authors.initials: R
authors.lastname: Bergström
authors.forename: I
authors.initials: I
authors.lastname: Fosdal
authors.forename: I
authors.initials: I
authors.lastname: Winnergård
authors.forename: K
authors.initials: K
authors.lastname: Hjälmås
mesh_terms: D000281:Administration, Intranasal; D002648:Child; D016001:Confidence Intervals; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004775:Enuresis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010349:Patient Compliance; D012076:Renal Agents / Q000008:administration & dosage*; D013548:Sweden
chemical_list: D012076:Renal Agents; D003894:Deamino Arginine Vasopressin