Factors Affecting the Clinical Response to Desmopressin Treatment for Primary Monosymptomatic Nocturnal Enuresis in Children.
Desmopressin shows a clinical response in about 60% of children with nocturnal enuresis, but one-third may relapse after treatment. Factors like age and medical history can influence outcomes.
Where it sits
this study against the rest of the desmopressin corpusSummary and findings
This study examined factors influencing the clinical response to desmopressin in children with primary monosymptomatic nocturnal enuresis (MNE). A total of 576 pediatric patients were analyzed, with a median age of 8 years. At 3 months, 60.1% of patients had a complete response to treatment.
Abstract
Desmopressin is the first-line treatment option for primary monosymptomatic nocturnal enuresis (MNE), particularly when nocturnal polyuria is a key symptom. This study aimed to investigate the factors affecting clinical response to desmopressin and relapse status in children with primary MNE during follow-up. Files of 576 paediatric patients presenting with primary MNE between September 2022 and March 2025, who commenced desmopressin treatment, were analysed retrospectively. The patients' demographic and clinical data were recorded. The clinical response to treatment was categorised according to the classification system of the International Children's Continence Society. A Cox regression analysis was performed to identify the factors that predict both treatment success and relapse. The median age of the patients was 8 (IQR 7-10) years, and 322 patients (55.9%) were male. At the 3-month follow-up, a complete response was observed in 346 patients (60.1%), a partial response in 102 patients (17.7%), whereas 128 patients (22.2%) had no clinical response. Of the 448 patients who showed a clinical response, 148 (33%) experienced a relapse following the discontinuation of desmopressin at a median follow-up period of 8 months. The results of the multivariable analysis identified advanced age at admission (≥ 11 years old) (HR: 1.949, p < 0.001), no history of SARS-CoV-2 (HR: 1.921, p < 0.001), absence of constipation (HR: 1.851, p = 0.039) and no history of allergy (HR: 1.769, p = 0.042) as factors increasing the clinical response to treatment. The factors that may have caused relapse during follow-up were: a history of SARS-CoV-2 (HR: 3.918, p = 0.007); a history of allergy (HR: 3.845, p = 0.001); advanced age at admission (≥ 11 years old) (HR: 3.105, p < 0.001); and constipation (HR: 2.936, p = 0.001). According to our findings, desmopressin induced a clinical response in around three-quarters of cases, but relapse was observed in around one-third of patients. Advanced age at admission (≥ 11 years old), a history of SARS-CoV-2 infection, constipation, and allergies were found to be predictors of treatment response and relapse rates during follow-up. As it was a retrospective study, registration was waived.
Background
This paper addresses the clinical response to desmopressin in treating primary monosymptomatic nocturnal enuresis (MNE) in children. Prior knowledge indicates desmopressin is a first-line treatment, but factors influencing its efficacy and relapse rates were not well understood. Understanding these factors is crucial for optimizing treatment strategies and improving patient outcomes.
Methods
The study employed a retrospective analysis of 576 pediatric patients diagnosed with primary MNE who began desmopressin treatment from September 2022 to March 2025. The primary outcome measure was the clinical response categorized by the International Children's Continence Society at a 3-month follow-up. Secondary outcomes included relapse rates and factors influencing treatment response.
Results
At the 3-month follow-up, a complete response was observed in 346 patients (60.1%), a partial response in 102 patients (17.7%), and no response in 128 patients (22.2%). Among the 448 patients who responded, 148 (33%) experienced a relapse at a median follow-up of 8 months. Factors predicting a better response included advanced age (HR: 1.949, p < 0.001) and absence of certain medical histories.
Interpretation
The findings suggest that desmopressin is effective in approximately 60% of cases, with a notable relapse rate of one-third among responders. While the statistical significance of predictors like age and medical history is clear, the clinical significance of these findings may vary. Limitations include the retrospective nature of the study and potential confounding factors that could influence the results.
Key findings
- Median age of patients was 8 years (IQR 7-10).
- Complete response in 346 patients (60.1%) at 3 months, n=576.
- Relapse in 148 patients (33%) at a median follow-up of 8 months, n=448.
- Advanced age at admission (≥ 11 years old) increased clinical response (HR: 1.949, p < 0.001).
- History of SARS-CoV-2 infection increased relapse risk (HR: 3.918, p = 0.007).
- Absence of constipation increased clinical response (HR: 1.851, p = 0.039).
Limitations
- Retrospective study design may introduce biases.
- Follow-up period of 8 months may not capture long-term outcomes.
- Single-site study limits generalizability.
- No randomization or control group.
- Potential confounding factors not fully accounted for.