Reboxetine in therapy-resistant enuresis: A randomized placebo-controlled study

Area of Science:

• Pediatric Nephrology
• Pharmacology
• Clinical Trials

Background:

• Many children with enuresis do not respond to standard treatments like desmopressin or alarms.
• Anticholinergics have shown limited success, and imipramine, a tricyclic antidepressant, carries cardiotoxicity risks.
• This necessitates exploring alternative, safer therapeutic options for refractory enuresis.

Purpose of the Study:

• To evaluate reboxetine, a noradrenergic antidepressant, as monotherapy or in combination with desmopressin for treatment-resistant childhood enuresis.
• To assess the efficacy and safety profile of reboxetine in this patient population.
• To identify potential prognostic factors from patient history and voiding charts.

Main Methods:

• A randomized, double-blind, placebo-controlled, cross-over study design was employed.
• Patients received treatment during three 4-week periods: reboxetine monotherapy, reboxetine plus desmopressin, and double placebo.
• Efficacy was measured by comparing the proportion of wet nights before and during treatment.

Main Results:

• Reboxetine, alone or with desmopressin, significantly reduced wet nights compared to placebo (p=0.002).
• Only one patient achieved complete dryness with monotherapy; intermediate responses were observed in 3 (monotherapy) and 5 (combination).
• Side effects were mild, reversible, and reported by 6 children on reboxetine monotherapy, 3 on combination therapy, and 2 on placebo.

Conclusions:

• Reboxetine is an evidence-based alternative to cardiotoxic antidepressants for therapy-resistant enuresis.
• The low dosage may explain the limited complete dryness; higher doses are used in clinical practice.
• Reboxetine shows promise as a treatment option for children with enuresis unresponsive to standard therapies.