Médecine Sorbonne Université, Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
Neurourol Urodyn. 2019 Feb;38(2):563-571. doi: 10.1002/nau.23921. Epub 2019 Jan 17.
To systematically assess all available evidence on efficacy and safety of desmopressin for treating nocturia in patients with multiple sclerosis (MS).
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus (last search March 3, 2018) and by screening of reference lists and reviews.
After screening of 7015 abstracts, 8 prospective, and 1 retrospective studies were included enrolling a total of 178 patients. The mean patient age ranged between 43 and 51 years. A significant decrease in the number of micturitions per night was reported in 5 studies. An increase in the maximum hours of uninterrupted sleep was only found in two studies. A significant reduction of the volume of nocturnal incontinence was described in one study. The patient satisfaction rates ranged from 56% to 82%. The rate of adverse events was between 0% and 57.9%. The rate of hyponatremia ranged from 0% to 23.5% and other commonly reported adverse events were headache, nausea, fluid retention, rhinitis/epistaxis, malaise, and swollen ankles. Risk of bias and confounding was relevant in all studies.
Preliminary data suggest that desmopressin might be effective for treating nocturia in patients with MS. However, adverse events are relatively common, the overall quality of evidence is low and the number of studied patients is very limited. Further studies with newer formulations of desmopressin are highly warranted.
系统评估所有关于去氨加压素治疗多发性硬化症（MS）患者夜尿症的疗效和安全性的证据。
本系统评价按照 Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA）声明进行。通过 Cochrane 注册、Embase、Medline、Scopus（最后一次搜索日期为 2018 年 3 月 3 日）的电子检索，以及参考文献列表和综述的筛选，确定了研究。
在筛选了 7015 篇摘要后，纳入了 8 项前瞻性研究和 1 项回顾性研究，共纳入了 178 名患者。患者的平均年龄在 43 至 51 岁之间。有 5 项研究报告夜间排尿次数明显减少，有 2 项研究发现最大无中断睡眠时间增加，有 1 项研究描述夜间遗尿量显著减少。患者满意度从 56%到 82%不等。不良事件发生率在 0%到 57.9%之间。低钠血症发生率从 0%到 23.5%不等，其他常见的不良事件包括头痛、恶心、体液潴留、鼻炎/鼻出血、不适和脚踝肿胀。所有研究的偏倚风险和混杂因素都很重要。
初步数据表明，去氨加压素可能对治疗多发性硬化症患者的夜尿症有效。然而，不良事件较为常见，总体证据质量较低，且研究患者数量非常有限。因此，非常需要使用去氨加压素的新制剂进行进一步的研究。
