title: Poor compliance with primary nocturnal enuresis therapy may contribute to insufficient desmopressin response.
abstract: OBJECTIVE
  Studies of desmopressin in children with primary nocturnal enuresis show a greater than 90% decrease in wet nights in 20% to 30%, a 50% to less than 90% decrease in 20% to 40% and less than a 50% decrease in up to 60%. Insufficient response to desmopressin is attributable to various factors, including differences in the primary nocturnal enuresis definition, underlying bladder dysfunction and/or desmopressin pharmacokinetic characteristics. However, little attention has been given to poor compliance with therapy as a possible explanatory factor. For a drug with an effect duration limited to the night after administration a high degree of compliance is essential to ensure consistent therapeutic effects.
  
  
  METHODS
  This was a substudy of an international investigation of treatment for 6 months or less with desmopressin tablets in children with primary nocturnal enuresis. Medication was dispensed at each visit as required and collected at each subsequent visit. Compliance was determined by pill counts by study staff.
  
  
  RESULTS
  Compliance data were available on 723 patients. Of the patients 81% to 91% ingested all medication as instructed during the initial run-in phases. However, this decreased to 77% and 71% during the first and second 3-month treatment periods, respectively.
  
  
  CONCLUSIONS
  Patient motivation and compliance are generally stronger in clinical trials than in clinical practice. However, this study shows that some patients were poorly compliant with medication even at study initiation and only 71% were fully compliant with long-term treatment. Decreased compliance was associated with a lower response rate. Patients should be encouraged to comply fully with treatment to achieve an optimal outcome.
authors.affiliation: Department of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Van Herzeele
authors.forename: Ilona
authors.initials: I
authors.lastname: Alova
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Paul
authors.initials: P
authors.lastname: Eggert
authors.forename: Henri
authors.initials: H
authors.lastname: Lottmann
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Nørgaard
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
mesh_terms: D000293:Adolescent; D050034:Antidiuretic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000188:drug therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin