title: Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: structured versus abrupt withdrawal.
abstract: OBJECTIVE
  To investigate whether a structured withdrawal program from a sublingual formulation of fast-melting oral desmopressin lyophilisate (MELT) is superior to a sudden withdrawal from this formulation in the treatment of monosymptomatic nocturnal enuresis.
  
  
  METHODS
  One hundred and three children presented to our pediatric nephrology outpatient clinic for bedwetting. Eighty-one children, aged between 5½ and 14 years (mean age 8.64 years), were treated with MELT at a dosage of 120 mcg a day. Responders were randomized to been withdrawn from therapy, after 3 months, abruptly or in a structured withdrawal program (60 mcg/day for 15 days and then 60 mcg every second evening for another 15 days). Main outcome parameter was relapse rate 1 month after the end of treatment. Relapse was defined as bedwetting occurring more than 2 nights per month after the 1-month treatment-free period.
  
  
  RESULTS
  Relapse rate at 1 month after the end of treatment was 47.83% in the group on a structured program versus 45.83% in the abrupt termination group (p = 0.89).
  
  
  CONCLUSIONS
  Our study suggests that a structured withdrawal program from MELT therapy doesn't offer advantages compared to an abrupt termination in children with monosymptomatic nocturnal enuresis.
authors.affiliation: Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy. Electronic address: pferrara@rm.unicatt.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrara
authors.affiliation: Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Romano
authors.affiliation: Campus Bio-Medico University, Rome, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Cortina
authors.affiliation: Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ianniello
authors.affiliation: Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Giovanna Carmela
authors.initials: GC
authors.lastname: Fabrizio
authors.affiliation: Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiaretti
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D050034:Antidiuretic Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004775:Enuresis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin
keywords: Enuresis; Fast-melting oral desmopressin lyophilisate; Treatment