Gradual tapering of desmopressin leads to better outcome in nocturnal enuresis.
BACKGROUND
Although desmopressin therapy is effective in treating polyuric monosymptomatic nocturnal enuresis (MNE), the relatively high rates of recurrence are problematic. To date, the treatment protocol on the discontinuation of oral desmopressin melt (ODM) tablet, MinirinMelt, has not been established. We tested two protocols of tapering ODM when the patients achieved full response on ODM, and compared the treatment outcomes.


METHODS
One hundred and fifty-seven polyuric MNE children were newly treated with ODM at the authors' outpatient clinics (Juntendo Nerima Hospital and Musashi-Murayama Hospital). When the patients did not respond to the 8 week ODM therapy, we added another options such as alarm, anti-cholinergics, and imipramine (92 patients; 58.6%). Sixty-five patients (41.4%) achieved full response on ODM alone, and 49 of them accepted gradual tapering of ODM: group B (n = 25), 240 μg ODM per day → 120 μg ODM per day → 120 μg ODM per alternate day → cessation; and group C (n = 24), 240 μg ODM per day → 120 μg ODM per day → 60 μg ODM per day → 60 μg ODM per alternate day → cessation.


RESULTS
Fourteen patients in group B (56%) and four in group C (17%) had relapses of enuresis after the discontinuation of ODM (P = 0.026).


CONCLUSIONS
Gradual tapering of ODM therapy in MNE patients leads to better outcome.
Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan.
Yoshiyuki
Y
Ohtomo
Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan.
Daisuke
D
Umino
Department of Pediatrics, Musashimurayama Hospital, Tokyo, Japan.
Masaru
M
Takada
Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan.
Shuichiro
S
Fujinaga
Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan.
Shinichi
S
Niijima
Department of Pediatrics and Adolescence, Juntendo University, Tokyo, Japan.
Toshiaki
T
Shimizu
D000293:Adolescent; D050034:Antidiuretic Agents / Q000008:administration & dosage; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000188:drug therapy* / Q000503:physiopathology; D010045:Outpatients; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014554:Urination / Q000187:drug effects* / Q000502:physiology
D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin
desmopressin; nocternal enuresis