Efficacy and Safety of Desmopressin Add-On Therapy for Men with Persistent Nocturia on alpha-Blocker Monotherapy for Lower Urinary Tract Symptoms: A Randomized, Double-Blind, Placebo Controlled Study

Abstract

Purpose: We investigated the efficacy and safety of desmopressin add-on therapy for men with persistent nocturia on alpha-blocker for lower urinary tract symptoms in this placebo controlled study. Materials and Methods: The study included men 40 to 65 years old with lower urinary tract symptoms and persistent nocturia despite alpha-blocker therapy for at least 8 weeks. Patients were randomized to once daily placebo or desmopressin 0.2 mg for 8 weeks. The primary end point was to assess changes in the mean number of nocturia episodes from baseline to the final assessment. Other secondary end points and adverse events were evaluated. Results and Limitation: A total of 86 patients were randomized to treatment, including placebo in 39 and desmopressin 0.2 mg in 47. Baseline characteristics were similar in the 2 groups. The desmopressin add-on group was significantly superior to placebo in terms of the change from baseline in the mean number of nocturia episodes (-1.13 +/- 0.92 vs -0.68 +/- 0.79, p = 0.034), the changes in nocturnal urine volume (p <0.001), total I-PSS (International Prostate Symptom Score) (p = 0.041), the nocturnal polyuria index (p = 0.001) and ICIQ-N (International Consultation on Incontinence Questionnaire-Nocturia) (p = 0.001), and the willingness to continue (p = 0.025). The incidence of adverse events in the desmopressin add-on group was similar to that in the placebo group. Most adverse events were mild. Conclusion: Desmopressin add-on therapy in men 40 to 65 years old with persistent nocturia on alpha-blocker monotherapy for lower urinary tract symptoms is effective and well tolerated.