Desmopressin for treating nocturia in men.
Objectives: To assess the effects of desmopressin as compared to other interventions in the treatment of nocturia in men.
Patients and methods: We performed a comprehensive search using multiple databases and abstract proceedings with no restrictions on the language of publication or publication status, up until August 2017. We included randomized or quasi-randomized trials. Inclusion criteria were men with nocturia defined as one or more voids per night. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the quality of the evidence (QoE) according to GRADE.
Results: We included 14 studies with 2966 randomized men across five comparisons (we did not include one comparison (desmopressin versus behavior modification) in the abstract due to lack of the data with regard to primary outcomes). DESMOPRESSIN VERSUS PLACEBO: based on short-term follow-up (up to three months), desmopressin may have a similar effect on the number of nocturnal voids (mean difference (MD) -0.46, 95% confidence interval (CI) -0.94 to 0.01; low QoE). We are uncertain about the effect of desmopressin on major adverse events (risk ratio (RR) 0.97, 95% CI 0.10 to 9.03; very low QoE). For intermediate-term follow-up (three to 12 months), desmopressin may reduce the number of nocturnal voids in an appreciable number of participants (MD -0.85, 95% CI -1.17 to -0.53; low QoE). Desmopressin may result in little or no difference in major adverse events (RR 3.05, 95% CI 0.13 to 73.39; low QoE). We found no evidence on quality of life. DESMOPRESSIN VERSUS ALPHA-BLOCKER (AB): based on short-term follow-up, desmopressin likely has a similar effect on the number of nocturnal voids (MD 0.30, 95% CI -0.20 to 0.80; moderate QoE) and quality of life (MD 0.00, 95% CI -0.35 to 0.35; moderate QoE). There were no major adverse events in either study group. DESMOPRESSIN PLUS AB VERSUS AB ALONE: based on short-term follow-up, combination therapy likely results in a small, unimportant reduction in the number of nocturnal voids (MD -0.47, 95% CI -0.73 to -0.21; moderate QoE) and quality of life (MD -0.29, 95% CI -0.51 to -0.07; moderate QoE). The risk of major adverse events may be similar (RR 0.30, 95% CI 0.01 to 7.32; low QoE). DESMOPRESSIN PLUS AB VERSUS AB PLUS AN ANTICHOLINERGIC: based on short-term follow-up, combination therapy likely results in little or no difference in the number of nocturnal voids (MD -0.43, 95% CI -0.97 to 0.11; moderate QoE). We found no evidence on quality of life. There were no major adverse events in either study group.
Conclusions: Desmopressin may reduce the number of nocturnal voids compared to placebo up to 12 months follow-up without increase in major adverse events. The effect on the number of nocturnal voids is likely similar to that of ABs with very infrequent major adverse events. There appears to be no added benefit in the combined use of an AB or an anticholinergic with desmopressin.