PMID-40728007 – Desmopressin for Nocturnal Enuresis Cochrane Review
Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev. 2025.
Quick Reference
| Property | Value |
|---|---|
| PMID | 40728007 |
| DOI | — |
| Year | 2025 |
| Journal | Cochrane Database of Systematic Reviews |
| Study Type | Systematic Review |
| Evidence Level | I |
| Sample | Multiple RCTs pooled; children with nocturnal enuresis |
| Peptide(s) Studied | Desmopressin |
Key Findings
- Desmopressin significantly reduces the number of wet nights per week in children with nocturnal enuresis compared to placebo
- Approximately 70% of children treated with desmopressin achieve complete dryness or significant reduction (>50%) in wet nights
- Best response rates observed in children over 10 years of age and those with nocturnal polyuria (concentrated morning urine)
- Relapse rates after discontinuation are substantial (approximately 50-60%), indicating the drug treats symptoms rather than curing the underlying condition
- Oral lyophilisate (melt) formulation shows equivalent efficacy to tablets with improved bioavailability
- Serious adverse events are rare; hyponatremia is the primary safety concern, mitigated by fluid restriction
Study Design
Cochrane systematic review of randomized controlled trials evaluating desmopressin for nocturnal enuresis in children. Comprehensive search of Cochrane Incontinence Specialised Register, CENTRAL, MEDLINE, and Embase. Included parallel-group and cross-over RCTs comparing desmopressin (any formulation) to placebo, no treatment, or other interventions. Risk of bias assessed using Cochrane RoB 2 tool. GRADE assessment for certainty of evidence.
Limitations
- High relapse rates after discontinuation limit the long-term clinical value
- Many included trials had short follow-up periods
- Heterogeneity in desmopressin dosing and formulations across trials
- Limited data on structured withdrawal protocols that may reduce relapse
- Some trials had unclear or high risk of bias for allocation concealment
Clinical Relevance
This Cochrane review represents the highest quality evidence for desmopressin's efficacy in pediatric nocturnal enuresis. It confirms desmopressin as a first-line pharmacological option alongside alarm therapy, particularly useful for short-term management (e.g., sleepovers, camps). The high relapse rate underscores the importance of structured withdrawal (gradual dose reduction) and combination approaches. For the peptide therapy context, this review demonstrates the clinical utility of selective V2 receptor agonism in managing conditions of renal water handling, illustrating how a small synthetic peptide (9 amino acids) can achieve targeted physiological effects with minimal off-target activity (unlike native vasopressin, which activates both V1 and V2 receptors).
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