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Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis

  • Pan Song,
  • Chuiguo Huang,
  • Yan Wang,
  • Qingwei Wang,
  • Wen Zhu,
  • Yiwei Yue,
  • Wancong Wang,
  • Jinjin Feng,
  • Xiangfei He,
  • Lingang Cui,
  • Tingxiang Wan,
  • Jianguo Wen
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China Department of Urology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China College of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan Province, China Department of Digest, The fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

Publication: BJU Int., Volume 123, Pages 388-400

DOI: 10.1111/bju.14539

Objective:

To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent (AA) therapy in the management of paediatric monosymptomatic nocturnal enuresis (MNE) using a network meta-analysis.

Materials and methods:
We searched the electronic databases PubMed, Cochrane Library, EMBASE and Web of Science from inception to 1 March 2018. Randomized controlled trials (RCTs) that compared desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AAs were identified. The network meta-analysis was conducted with software R 3.3.2 and STATA 14.0.

Results:
Eighteen RCTs with a total of 1649 participants were included. The meta-analysis results showed that complete response (CR) and success rates with desmopressin plus AAs were higher than with desmopressin or alarm monotherapy. Success rates for desmopressin plus alarm therapy were higher than for alarm monotherapy. No obvious difference was observed between desmopressin plus AAs and desmopressin plus alarm therapy with regard to CR rate and success rate. The relapse rate with alarm monotherapy was much lower than with desmopressin monotherapy. Adverse events seemed to be infrequently and tolerable for all treatments. The ranking probability results were as follows: desmopressin plus AA ranked first for the outcomes of CR and success, desmopressin plus alarm therapy ranked first for mean number of wet nights per week, and alarm therapy had the lowest relapse rate.

Conclusions:
The network meta-analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AAwere associated with tolerable adverse events; however, additional high-quality studies are needed for further evaluation of these treatments.