Systematic review and meta-analysis of randomized control trials addressing efficacy and safety of desmopressin for females with nocturia

Abstract

Aim:To conduct a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that evaluated the efficacy and safety of desmopressin versus placebo among females with nocturia. Methods:PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar databases were searched from inception until 15-November-2022. The included studies were evaluated for risk of bias (Cochrane Tool). The endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Subgroup analysis based on the dose of desmopressin ( ≤50μg and >50μg) was conducted. In addition, meta-regression was performed to examine the impact of age and body mass index (BMI) on the endpoints. Results:Nine RCTs with 2852 patients (desmopressin=1110, placebo=1742) were analyzed. The overall risk of bias was low. Compared with placebo, desmopressin significantly reduced the mean number of nocturnal voids (MD=-0.51, 95% CI [-0.70, -0.31], p<0.001), prolonged the duration of the first sleep period (MD=69.06 min, 95% CI [46.54, 91.59], p<0.001), and increased the 33% responder rate (RR=1.30, 95% CI [1.13, 1.50], p<0.001). Subgroup analyses according to desmopressin dose ( ≤50μg and >50μg) showed similar significant differences compared with placebo. Meta-regression showed less improvement in the number of nocturnal voids with the increased age and BMI. There was no significant difference between both groups regarding the rate of overall adverse events (RR=1.11, 95% [0.94, 1.32], p=0.22). Conclusion:Desmopressin was safe and effective in improving nocturia among females. Higher dose of desmopressin (>50μg) correlated with better efficacy. Age and BMI impacted the mean number of nocturnal voids.