Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review

doi:10.1016/j.ajur.2021.05.005

Asian Journal of Urology, 2022, 9 (1): 27-34 doi: 10.1016/j.ajur.2021.05.005

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Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review

Bara Barakat^a,*(

),Knut Franke^a,Matthias May^b,Ulrich Gauger^c,Thomas-Alexander Vögeli^d

^a Hospital Viersen, Department of Urology and Pediatric Urology, Viersen, Germany
^b Hospital St. Elisabeth, Department of Urology, Straubing, Germany
^c Institute for Medical Statistics, Berlin, Germany
^d University Hospital RWTH Aachen, Department of Urology and Pediatric Urology, Aachen, Germany

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Abstract

Objective: To evaluate the efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder (OAB) and nocturia.
Methods: A selective database search was conducted to validate the effectiveness of desmopressin in patients with OAB and nocturia. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilised. The meta-analysis included 378 women (five studies) with OAB. The clinical outcomes and adverse events were analysed.
Results: The treatment strategy of all the studies included can be divided into three categories: (1) The effect of desmopressin compared with baseline, (2) desmopressin compared with placebo, and (3) desmopressin and anticholinergic combination versus desmopressin monotherapy. There was a significant (50%) reduction in nocturia and urgency episodes after using desmopressin alone. Combined desmopressin and anticholinergic led to a decrease in the frequency of nocturia voids when only using anticholinergic (65% vs. 33.2%). The time increased in the middle to the first nightly voids in the combination arm (65.11 min; p=0.045). The mean incidence (standard deviation) of leak-free episodes was higher under desmopressin than under placebo in the first 4 h (62% [35%] vs. 48% [40%]) and in the first 8 h (55% [37%] vs. 40% [41%]). The safety profile was comparable between treatments.
Conclusion: Available data indicate that desmopressin is efficacious in significantly reducing nighttime urine production, episodes of nocturia, and urgency episodes. The affectivity of the combination therapy was very high with least side effects for the treatment of OAB/nocturnal polyuria.

Key words： Overactive bladder Nocturia Desmopressin Urinary urgency Lower urinary tract

Received: 19 April 2020 Available online: 20 January 2022

Corresponding Authors: Bara Barakat E-mail: dr.barakat3@googlemail.com

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Bara Barakat,Knut Franke,Matthias May, et al. Efficacy and safety of desmopressin on frequency and urgency in female patients with overactive bladder and nocturia, current clinical features and outcomes: A systematic review[J]. Asian Journal of Urology, 2022, 9(1): 27-34.

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http://www.ajurology.com/EN/10.1016/j.ajur.2021.05.005 OR http://www.ajurology.com/EN/Y2022/V9/I1/27

Study selection flow chart, Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. OAB, overactive bladder; CENTRAL, the Cochrane Central Register of Controlled Trials.

References	Study type	Therapy	Number of patients	Age, year	Mean follow-up, week
Rovner et al., 2018 [21]	- RCT, double-blind, proof-of-concept	- Combination therapy (DDAVP 25 μg + tolterodine 4 mg) vs. monotherapy (tolterodine 4 mg/placebo)	49 vs. 57	55 vs. 51	12
Han et al., 2011 [22]	- RCT, design open label	- Combination therapy (DDAVP 0.2 mg + solifenacin 5 mg) vs. monotherapy (solifenacin 5 mg)	37 vs. 31	52 vs. 56	4
Mun et al., 2015 [19]	- Prospective	- DDAVP (0.1 mg) vs. baseline	60	69	12
Jeong et al., 2013 [20]	- Prospective	- DDAVP (0.1 or 0.2 mg) vs. baseline	84	66	8
Robinson et al., 2004 [17]	- RCT, double-blind, proof-of-concept	- DDAVP (40 μg; nasal spray) vs. placebo	60 vs. 57	58 vs. 55	4
References	Nocturnal voids, mean, n	Day-time voids, mean, n	Time to first nocturnal void and urgency, mean, min	Mean nocturnal urine volume, mL	Urgency episodes, mean, n
Rovner et al., 2018 [21]	3.11 vs. 3.38	9.69 vs.10.10	125 vs.143	546 vs. 537	2.94 vs. 3.56
Han et al., 2011 [22]	3.2 vs. 4.5	NR	187 vs.196	<150 (n=15) vs. ≥150 (n=22)	2.8 vs. 3.2
Mun et al., 2015 [19]	2.00 vs. 3.63	857 vs.1054	NR	478.3 vs. 706.2	1.66 vs. 2.67
Jeong et al., 2013 [20]	1.4 vs. 3.7	NR	NR	NR	3.3 vs. 4.2
Robinson et al., 2004 [17]	NR	1180 vs. 1375	312 vs. 378	237 vs. 317	2.1 vs. 2.3
References	QoL		Clinical evaluation		Adverse events^a, n (%)
Rovner et al., 2018 [21]	- Significantly reduced number of nocturia episodes (Q12) (TC, -13.85; p=0.062)		- 3-day diary, NI QoL, EQ-5D-5L™, Sleep Rating Scale		21 (44) vs. 28 (51)
Han et al., 2011 [22]	- Significantly reduced number of nocturia episodes		- UDI-6, IIQ-7		2 (5.4)
Mun et al., 2015 [19]	- Significantly reduced number of nocturia episodes Sleep index (p=0.003) Sleep disturbance (p=0.001) Snoring (p=0.028) Shortness of breath (p=0.036)		- Questionnaires (MOS) sleep scale, NPI, NI, functional bladder capacity		8 (13.3)
Jeong et al., 2013 [20]	- Significantly reduced number of nocturia episodes		- Urinalysis, urinary sensation scale, 3-day frequency volume chart, NP, RNBC, IPSS		NR
Robinson et al., 2004 [17]	- Significantly reduced number of nocturia episodes		- NR		35 (58) vs.15 (25)

Demographic characteristics, therapeutic effects, and adverse effects of desmopressin therapy in the comparative studies.

Meta-analysis for mean number of nocturnal voids of desmopressin alone on overactive bladder. SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.

Meta-analysis for mean number of urgency episodes of desmopressin alone on overactive bladder. SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.

Meta-analysis of desmopressin combined with anticholinergic on overactive bladder. SMD, standardised mean difference; CI, confidence interval; TE, estimate of treatment effect; seTE, standard error of treatment estimate.

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