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Desmopressin Plus Tolterodine vs Desmopressin Plus Indomethacin for Refractory Pediatric Enuresis: An Open-label
Maryam Esteghamati1, Seyedeh Elaheh Mousavi2, Ghazal Zoghi3
1Department of Pediatric Nephrology, Clinical Research Development Center of Children's Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Correspondence to: Dr Maryam Esteghamati, Department of Pediatric Nephrology, Clinical Research Development Center of Childern's Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. maryamesteghamati@gmail.com.
Insights
Desmopressin plus tolterodine (D+T) is more effective than desmopressin plus indomethacin (D+I) for treating pediatric enuresis resistant to desmopressin. D+T showed significantly higher nocturnal enuresis reduction and complete response rates.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Urology
Background:
- Pediatric enuresis is a common condition affecting children's quality of life.
- Desmopressin monotherapy is a first-line treatment but can be ineffective in some cases.
- Combination therapy may offer improved outcomes for refractory enuresis.
Purpose of the Study:
- To compare the efficacy of desmopressin plus tolterodine (D+T) versus desmopressin plus indomethacin (D+I) in children with desmopressin-resistant enuresis.
- To evaluate treatment response and adverse events associated with each combination therapy.
Main Methods:
- An open-label randomized controlled trial was conducted with 40 children aged over five years.
- Participants with primary enuresis resistant to desmopressin were randomized to receive either D+T or D+I nightly for five months.
- Efficacy was assessed by the reduction in enuresis frequency and complete treatment response at one, three, and five months.
Main Results:
- Desmopressin plus tolterodine (D+T) demonstrated significantly greater efficacy than desmopressin plus indomethacin (D+I) in reducing nocturnal enuresis frequency at all time points (1, 3, and 5 months).
- At five months, complete treatment response was only observed in the D+T group, while treatment failure was higher in the D+I group (50% vs 20%).
- No significant cutaneous drug reactions or central nervous system symptoms were reported in either treatment group.
Conclusions:
- Desmopressin plus tolterodine (D+T) is a superior treatment option compared to desmopressin plus indomethacin (D+I) for pediatric enuresis refractory to desmopressin monotherapy.
- Combination therapy with D+T offers a promising and safe alternative for managing resistant enuresis in children.
Objective:
To compare the efficacy of desmopressin plus tolterodine (D+T) with desmopressin plus indomethacin (D+I) for treating enuresis in children.
Design:
Open-label randomized controlled trial.
Setting:
Bandar Abbas Children's Hospital, a tertiary care children's hospital in Iran, from March 21, 2018, to March 21, 2019.
Participants:
40 children older than five years with monosymp-tomatic and non-monosymptomatic primary enuresis resistant to desmopressin monotherapy.
Intervention:
Patients were randomized to receive either D+T (60 µg sublingual desmopressin and 2 mg tolterodine) or D+I (60 µg sublingual desmopressin and 50 mg indomethacin) every night before bedtime for five months.
Outcome:
Reduction in the frequency of enuresis was evaluated at one, three, and five months, and response to treatment at five months. Drug reactions and complications were also noted.
Results:
After adjustment for age, consistent incontinence from toilet training, and non-monosymptomatic enuresis, D+T was significantly more efficacious than D+I; mean (SD) percent in nocturnal enuresis reduction at 1 [58.86 (7.27)% vs 31.18 (3.85) %; P<0.001], 3 [69.78 (5.99) % vs 38.56 (3.31) %; P<0.000], and 5 [84.84(6.21) % vs 39.14 (3.63) %; P<0.001] months showing a large effect. At 5 months, complete response to treatment was only observed with D+T, while treatment failure was significantly higher with D+I (50% vs 20%; P=0.047). None of the patients in either group developed cutaneous drug reactions or central nervous system symptoms.
Conclusion:
Desmopressin plus tolterodine appears to be superior to desmopressin plus indomethacin for treating pediatric enuresis resistant to desmopressin.
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