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Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: structured versus abrupt withdrawal

Pietro Ferrara1, Valerio Romano1, Ivana Cortina2

  • 1Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.

Journal of Pediatric Urology
|June 25, 2013
PubMed

Insights

Structured withdrawal from desmopressin lyophilisate (MELT) did not reduce relapse rates for nocturnal enuresis compared to abrupt cessation. This finding suggests abrupt discontinuation is a viable option for managing bedwetting in children.

Area of Science:

  • Pediatric Nephrology
  • Sleep Medicine
  • Pharmacology

Background:

  • Monosymptomatic nocturnal enuresis is common in children.
  • Desmopressin is a standard treatment for nocturnal enuresis.
  • The optimal method for discontinuing desmopressin therapy is not well-established.

Purpose of the Study:

  • To compare the efficacy of a structured withdrawal program versus abrupt cessation of desmopressin lyophilisate (MELT) in treating monosymptomatic nocturnal enuresis.
  • To determine if a gradual reduction in MELT dosage reduces relapse rates after treatment cessation.

Main Methods:

  • A randomized controlled trial involving 81 children aged 5.5–14 years treated with MELT (120 mcg/day).
  • Responders were randomized to either abrupt withdrawal or a structured 30-day tapering program.
  • Relapse was defined as >2 nights of bedwetting per month, assessed 1 month post-treatment.

Main Results:

  • The relapse rate at 1 month post-treatment was 47.83% in the structured withdrawal group and 45.83% in the abrupt termination group.
  • There was no statistically significant difference in relapse rates between the two withdrawal methods (p = 0.89).

Conclusions:

  • A structured withdrawal program from desmopressin lyophilisate (MELT) does not offer significant advantages over abrupt termination in preventing relapse of monosymptomatic nocturnal enuresis.
  • Abrupt cessation appears to be a similarly effective strategy for discontinuing MELT therapy in this pediatric population.
Abstract

Keywords:
EnuresisFast-melting oral desmopressin lyophilisateTreatment

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