The pooled analysis evaluates the therapeutic efficacy of desmopressin combined with anticholinergic drugs in the treatment of pediatric nocturnal enuresis

医学 去氨加压素 优势比 抗胆碱能 遗尿 置信区间 不利影响 荟萃分析 相对风险 科克伦图书馆 随机对照试验 内科学 羟丁酸 联合疗法 儿科 膀胱过度活动 病理 替代医学
作者
Gonglin Tang,Hongquan Liu,Gang Wu,Guixin Ding,Yongli Chu,Yuanshan Cui,Jitao Wu
出处
期刊:Neurourology and Urodynamics [Wiley]
卷期号:43 (1): 183-195
标识
DOI:10.1002/nau.25295
摘要

Abstract Objective This pooled analysis aims to demonstrate the clinical efficacy and safety of combined desmopressin and anticholinergic therapy in the treatment of pediatric nocturnal enuresis (NE). Methods A systematic search was conducted through PubMed, MEDLINE, EMBASE, ResearchGate, and Cochrane Library to identify all randomized controlled trials (RCTs) comparing monotherapy with desmopressin versus combined therapy with desmopressin and anticholinergic agents for the treatment of NE. Data analysis was performed using RevMan version 5.4.1. Results This study included 8 RCTs involving a total of 659 patients. The frequencies of complete response (CR), partial response (PR), and nonresponse (NR) were computed for both short‐term treatment (1 month) and long‐term treatment (3 months). Additionally, alterations in the mean number of NE episodes, adverse events, and relapse were assessed. Our analysis indicates that, in comparison to the monotherapy group, the combination therapy group plays a pivotal role in augmenting the CR odds and diminishing the NR ratios in both short‐term and long‐term treatments (1 month CR ratio [risk ratio (RR): 1.84; 95% confidence interval (CI): 1.22–2.76; p = 0.003, I 2 = 72%]; 3 months CR ratio [RR: 1.48; 95% CI: 1.25–1.76; p < 0.00001, I 2 = 0%]; 1 month NR ratio [RR: 0.67; 95% CI: 0.55–0.82; p = 0.0001, I 2 = 0%]; 3 months CR ratio [RR: 0.37; 95% CI: 0.19–0.73; p = 0.004, I 2 = 0%]). Furthermore, in both short‐term and long‐term treatment, the combined therapy group exhibits a greater magnitude of change in the average number of NE episodes compared to patients receiving monotherapy (1 month, mean difference [MD] = −2.97; 95% CI: −4.23 to −1.71, p < 0.0001; 3 months, MD = −4.30; 95% CI: −7.18 to −1.43, p = 0.003). Moreover, the combination therapy group exhibits a significant reduction in the recurrence rate (RR: 0.36; 95% CI: 0.15–0.86; p = 0.02). There is no significant difference in the incidence of adverse events between the two groups (RR: 1.16; 95% CI: 0.58‐2.31; p = 0.67). Conclusion Combining desmopressin with anticholinergic medications is more effective for NE than desmopressin alone, with lower recurrence and minimal adverse effects.
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