title: Desmopressin melt improves response and compliance compared with tablet in treatment of primary monosymptomatic nocturnal enuresis.
abstract: Primary nocturnal enuresis is a prevalent childhood condition that can persist into adulthood. Desmopressin is an antidiuretic available as orally disintegrating lyophilisate (melt) or solid tablet. Recent findings suggesting different food interactions and clinical characteristics, including compliance, between desmopressin melt and tablet motivated a post hoc analysis of a previously reported randomised, crossover study. The efficacy of desmopressin melt compared with tablet was evaluated using the International Children's Continence Society (ICCS) responder definitions. Compliance was further analysed using detailed criteria, and the association between efficacy and compliance was examined. In total, 221 patients aged 5-15 years, already receiving desmopressin tablets were randomised to the treatment sequence melt (120/240 μg)/tablet (0.2/0.4 mg) or tablet/melt in two consecutive 3-week periods. The probability of being a responder (partial or full) during either period was significantly more likely with desmopressin melt compared with tablet (odds ratio, 2.0; confidence intervals, 1.07-3.73; p = 0.03). There was no period effect on compliance in the tablet/melt sequence and no difference in the number of completely compliant patients in each formulation group; however, more patients were >75 % compliant in period 1 compared with period 2 in the melt/tablet sequence. Increased compliance was associated with greater reductions in the number of wet nights for both formulations.
  
  
  CONCLUSIONS
  Desmopressin melt, compared with tablet, improves the probability of being a responder. Switching from tablet to melt formulation increased patient compliance. Increased compliance was associated with increased efficacy. Switching to desmopressin melt may benefit patients with suboptimal responses to desmopressin tablet.
authors.affiliation: Ferring International PharmaScience Center, Kay Fiskers Plads 11, 2300 Copenhagen, Denmark. KristianVinter.Juul@ferring.com
authors.forename: Kristian Vinter
authors.initials: KV
authors.lastname: Juul
authors.forename: Charlotte
authors.initials: C
authors.lastname: Van Herzeele
authors.forename: Pauline
authors.initials: P
authors.lastname: De Bruyne
authors.forename: Sandra
authors.initials: S
authors.lastname: Goble
authors.forename: Johan Vande
authors.initials: JV
authors.lastname: Walle
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Nørgaard
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D050034:Antidiuretic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D018592:Cross-Over Studies; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005612:Freeze Drying; D006801:Humans; D016015:Logistic Models; D008297:Male; D053206:Nocturnal Enuresis / Q000188:drug therapy*; D016017:Odds Ratio; D013607:Tablets; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D050034:Antidiuretic Agents; D013607:Tablets; D003894:Deamino Arginine Vasopressin