A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children / 临床儿科杂志

ABSTRACT

Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate OR=2.8, 95％ CI1.5～5.4; success rate OR=3.5, 95％ CI1.7～7.5) and alarm (complete response rate OR=2.7, 95％ CI1.1～6.6; success rate OR=3.8, 95％ CI 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.