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Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta‐analysis
Author(s) -
Song Pan,
Huang Chuiguo,
Wang Yan,
Wang Qingwei,
Zhu Wen,
Yue Yiwei,
Wang Wancong,
Feng Jinjin,
He Xiangfei,
Cui Lingang,
Wan Tingxiang,
Wen Jianguo
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14539
Subject(s) - desmopressin , medicine , anticholinergic , meta analysis , enuresis , anesthesia , urology
Objective To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent ( AA ) therapy in the management of paediatric monosymptomatic nocturnal enuresis ( MNE ) using a network meta‐analysis. Materials and methods We searched the electronic databases PubMed, Cochrane Library, EMBASE and Web of Science from inception to 1 March 2018. Randomized controlled trials ( RCT s) that compared desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AA s were identified. The network meta‐analysis was conducted with software R 3.3.2 and STATA 14.0. Results Eighteen RCTs with a total of 1 649 participants were included. The meta‐analysis results showed that complete response (CR) and success rates with desmopressin plus AA s were higher than with desmopressin or alarm monotherapy. Success rates for desmopressin plus alarm therapy were higher than for alarm monotherapy. No obvious difference was observed between desmopressin plus AA s and desmopressin plus alarm therapy with regard to CR rate and success rate. The relapse rate with alarm monotherapy was much lower than with desmopressin monotherapy. Adverse events seemed to be infrequently and tolerable for all treatments. The ranking probability results were as follows: desmopressin plus AA ranked first for the outcomes of CR and success, desmopressin plus alarm therapy ranked first for mean number of wet nights per week, and alarm therapy had the lowest relapse rate. Conclusions The network meta‐analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AA were associated with tolerable adverse events; however, additional high‐quality studies are needed for further evaluation of these treatments.