deamino-arginine-vasopressin and Multiple-Sclerosis

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.

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Multiple Sclerosis; Nocturia; Treatment Outcome

Since lower urinary tract dysfunction (LUTD) related to multiple sclerosis (MS) has a different behavior pattern than other types of neurogenic voiding dysfunction, we aimed to prepare a national consensus report for the management of LUTD due to multiple sclerosis in light of available literature.. A search of available databases yielded an evidence base of 125 articles after the application of inclusion/exclusion criteria. When sufficient evidence existed, recommendations A (high), B (moderate), or C (low) were made according to the strength of evidence; recommendation D was provided when insufficient evidence existed.. Available data did not support the use of invasive urodynamics in the initial evaluation of patients with MS and LUTD. Clinical studies on the safety and efficacy of antimuscarinics and alpha-blockers in these patients were scarce and low quality. Desmopressin could be used in MS-related overactive bladder symptoms owing to its short-term effects as an adjunctive treatment. Intravesical botulinum toxin type A treatment in patients with MS and detrusor overactivity was recommended in cases of medical treatment failure or severe side effects due to antimuscarinics. Pelvic floor rehabilitation together with neuromuscular electrical stimulation was also recommended as it increased symptomatic treatment success. This systematic review was not able to find any evidence-based cut off post-void residual value for the recommendation to start clean intermittent catheterization in MS-related LUTD.. Patients with MS and LUTD could be best managed through the use of this consensus report.

Topics: Consensus; Deamino Arginine Vasopressin; Humans; Lower Urinary Tract Symptoms; Multiple Sclerosis; Pelvic Floor; Turkey; Urodynamics

The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence.. A literature search was carried out looking for studies published between 1990 and 2003 which evaluated desmopressin in MS patients with bladder dysfunction.. The grand total mean effect sizes show the following estimates of clinical relevant differences: desmopressin has a moderate effect on the number of voids during the day or during the night over a period of 6 h after taking the drug. A large effect associated with the use of desmopressin was detected by the mean difference in urine volume (ml) in 6 h. A small effect was detected in the mean 24-h urine volume. Serum sodium levels were combined with plasma osmolality in some studies and were found to be not significantly affected by desmopressin treatment.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Osmolar Concentration; Renal Agents; Sodium; Treatment Outcome; Urinary Bladder, Neurogenic; Urination; Water-Electrolyte Balance

Topics: Deamino Arginine Vasopressin; Enuresis; Humans; Multiple Sclerosis; Randomized Controlled Trials as Topic; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

Twenty two patients with multiple sclerosis, complaining of frequency of day time micturition, completed a double blind crossover trial of desmopressin (DDAVP nasal spray) versus placebo. There was a significant decrease in micturition frequency in the 6 hour post-treatment period from 3.1 voids after placebo to 2.4 voids and a significant reduction in urinary volume after desmopressin. Eighty per cent of patients preferred the active treatment phase. Mean 24 hour urinary volume did not differ between active and placebo treatments and patients did not complain of increased night time frequency. Transient symptoms of hyponatraemia occurred in one patient but these resolved within 48 hours of stopping desmopressin. There were otherwise no side effects and mean serum sodium concentrations of the group remained unchanged throughout the study. The clinical indications for prescribing daytime desmopressin are discussed and the importance of patient compliance stressed.

Topics: Adolescent; Adult; Aged; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Patient Compliance; Renal Agents; Sodium; Treatment Outcome; Urination Disorders

Bladder dysfunction with increased voiding frequency and incontinence is a common problem in patients with multiple sclerosis (MS). In the present study, the effect of the synthetic vasopressin analogue, desmopressin, was evaluated on the voiding frequency in 26 patients with MS suffering from socially handicapping voidings and incontinence problems during daytime. A two-week run-in observation period to establish normal voiding patterns was followed by a double-blind, placebo-controlled cross-over study with 20 micrograms intranasal desmopressin during daily activities. There was a significant decrease in the number of voidings during the 6-h period after intranasal intake of desmopressin. Side effects were well tolerated and there was no hyponatremia or hypertension registered. Intranasal desmopressin is an efficient and well-tolerated treatment of voiding problems in patients with MS during daily activities.

Topics: Administration, Intranasal; Adult; Aged; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Urinary Bladder Diseases

Neurogenic bladder affects up to 80% of patients with multiple sclerosis (MS) and, in 50% of these patients, it is a significant cause of disability. The current management of neurogenic bladder, based on fluid restriction, anticholinergic agents, intermittent self-catheterization, and, in some cases, surgical intervention, often fails to relieve all symptoms. Furthermore, anticholinergic drugs have significant adverse effects and may be medically contraindicated. Nocturia is a particularly disabling symptom of neurogenic bladder; by disrupting sleep patterns, it aggravates the chronic fatigue of MS, imposes serious demands on caregivers, and can lead to institutionalization. To evaluate a novel approach to the symptomatic management of nocturia in patients with MS, we have conducted a trial of desmopressin acetate (1-desamino-8-D-arginine vasopressin), a synthetic analogue of antidiuretic hormone.. To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS.. Seventeen patients were enrolled in a double-blind, crossover trial of desmopressin administered at bedtime. Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial.. Desmopressin reduced the percentage of nights with nocturia in patients from 97% to 66%. The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77. These results were highly significant. Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia.. Desmopressin was found effective; no tolerance and only minimal adverse effects have been observed. Our results suggest that desmopressin, either alone or in combination with other therapeutic modalities, is effective in the symptomatic management of nocturia in patients with MS. The only adverse effect attributed to desmopressin was hyponatremia, which occurred in 4 of 17 patients and appeared to be dose related.

Topics: Adult; Aged; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Renal Agents; Urinary Bladder, Neurogenic; Urination Disorders

To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis.. Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in-patients into an open, nonrandomized, placebo-controlled study of incremental doses of 20, 40 and 60 micrograms desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24-h periods.. There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo, but there was no difference among the desmopressin doses. There was no significant difference in serum sodium level between the desmopressin doses. However, at the end of the 24-h period with the 60 micrograms dose, serum sodium was decreased significantly.. Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 micrograms. A dose of 60 g was associated with a decreased serum sodium level at the end of the 24-h period but there was no biochemical hyponatraemia. Because there were no benefits and a possibility of clinical hyponatraemia with higher doses, doses of > 20 micrograms desmopressin cannot be recommended.

Topics: Adult; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Female; Humans; Hyponatremia; Middle Aged; Multiple Sclerosis; Osmolar Concentration; Renal Agents; Sodium; Urination; Urination Disorders

To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis.. Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out.. Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia.. Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

Topics: Adult; Cross-Over Studies; Deamino Arginine Vasopressin; Double-Blind Method; Enuresis; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Urination Disorders

Thirteen patients with advanced multiple sclerosis and urge urinary incontinence were treated with desmopressin--a synthetic analogue of antidiuretic hormone--in a double-blind cross-over study. The micturition frequency decreased significantly (p less than 0.05). Less leakage was considered valuable for daily life. Peroral medication was favourable in these patients with muscular dysfunction. Side-effects were few.

Topics: Administration, Oral; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Randomized Controlled Trials as Topic; Urinary Bladder, Neurogenic; Urinary Incontinence

Multiple sclerosis (MS) is the commonest progressive neurological disease affecting young people. With advancing disease, management of neurogenic detrusor overactivity (NDO) based on antimuscarinics may prove inadequate and if based on botulinum toxin, may necessitate clean intermittent self-catheterization. The aim of the study was to evaluate the effectiveness of combined mirabegron and desmopressin administration in the treatment of NDO in patients with MS.. Sixty patients diagnosed with MS and NDO were evaluated. All had received treatment with solifenacin 10 mg/daily for 3 months and were displeased with the results. Patients were divided in four groups. In Group A (n = 15) patients continued receiving solifenacin 10 mg/daily; in Group B (n = 15) patients received mirabegron 50 mg/daily; in Group C (n = 15) patients received desmopressin 120 mcg/daily and in Group D (n = 15) patients received mirabegron 50 mg/daily and desmopressin 120 mcg/daily. All patients were assessed with a 3 day bladder diary at the beginning and at the end of the treatment.. All patients in Groups A, B and C did not demonstrate statistically significant changes at the end of the treatment period in their 3 day bladder diary and in the presence of urinary infections. In Group D, a statistically significant improvement was noted in the mean change from baseline to end of treatment in micturition episodes (3.5 +/- 0.4 micturition/24h), in urgency episodes (2.3 +/- 0.2) and mean number of urinary incontinence (1.0 +/- 0.2 episodes/24h).. Treatment with mirabegron and desmopressin revealed both effectiveness and safety in patients with NDO and MS.

Topics: Acetanilides; Adrenergic beta-3 Receptor Agonists; Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Muscarinic Antagonists; Retreatment; Solifenacin Succinate; Thiazoles; Urinary Bladder, Neurogenic; Urinary Bladder, Overactive; Urinary Incontinence; Urination

Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 mls. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. There are specific situations where specialist urology services should be involved.

Topics: Algorithms; Antidiuretic Agents; Botulinum Toxins, Type A; Community Health Nursing; Deamino Arginine Vasopressin; Humans; Multiple Sclerosis; Muscarinic Antagonists; Neuromuscular Agents; Nursing Assessment; Referral and Consultation; Risk Factors; Self Care; Urinary Bladder, Overactive; Urinary Catheterization; Urinary Tract Infections; Urination Disorders; Urodynamics

The aim of the study is to evaluate the efficacy of desmopressin therapy in the symptomatic treatment of nocturia in patients with multiple sclerosis (MS) and neurogenic detrusor overactivity, and to investigate the validity of maximal bladder capacity as a predictor of response to intranasal desmopressin inhalation.. A set of 20 women with MS and neurogenic detrusor overactivity enrolled in a prospective pilot study and were divided into two groups: Group A, the large bladder capacity group (maximal bladder capacity >250 ml, compliance >20 ml/cm H(2)O, n=10) and Group B, the small bladder capacity group (maximal bladder capacity <250 ml, compliance <20 ml/cm H(2)O, n=10). Maximal bladder capacities were measured by urodynamic evaluation. The dosage selected for the study was based on the established dose of commercially available desmopressin nasal spray (20 mug before bedtime) and on clinical trial experience. All patients were monitored for arterial blood pressure before and after treatment and for weight increase for the first 5 days of treatment. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and urine osmolality were measured twice weekly during the trial.. The mean volume of nocturnal incontinence decreased significantly in both groups (P<0.005). The average number of episodes of nocturia per night in Group A decreased from 2.35 to 0.89 and in Group B from 2.31 to 1.65. The maximum hours of sleep uninterrupted by nocturia increased from 2.54 to 4.62 in Group A and from 2.45 to 3.23 in Group B. Side effects were infrequent; only 2 patients complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred.. Our results suggest that desmopressin is effective in the symptomatic management of nocturia in patients with MS and neurogenic detrusor overactivity. Maximal bladder capacity is a valuable predictor of response to desmopressin.

Topics: Administration, Intranasal; Antidiuretic Agents; Deamino Arginine Vasopressin; Female; Humans; Middle Aged; Multiple Sclerosis; Nocturia; Pilot Projects; Prospective Studies; Sleep; Time Factors; Treatment Outcome; Urinary Bladder; Urodynamics

Multiple Sclerosis (ME) is a chronic progressive disease characterized by relapses of demyelination that can occur anywhere in the brain stem, spinal cord and optic nerve. Since central diabetes insipidus (DI) is mainly caused by central nervous system damage (such as trauma, surgery, tumor, infection, sarcoidosis), ME is included among its possible etiologies. However, this association is not commonly described. The clinical suspicion must be made in the presence of polyuria and polydipsia or refractory hypernatremia (in patients without free access to water) during the evolution of ME. We will describe a clinical report in which this association occurred and, after the beginning of desmopressin therapy, the clinical findings were reverted.

Topics: Adult; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Diagnosis, Differential; Female; Humans; Magnetic Resonance Spectroscopy; Multiple Sclerosis; Polyuria

The benefit of desmopressin (DDAVP) in the treatment of the urinary symptoms of multiple sclerosis has until now only been shown in short crossover studies of up to 6 weeks. We report 19 patients who have used the drug for an average of 2 years and 4 months, 18 of whom confirmed continued dramatic benefit without any obvious change in dosage used or efficacy and with few side effects. Ten of the 19 patients had also used DDAVP during daytime for special occasions with notable success. This is the first study to suggest that DDAVP is safe and effective in long term use in MS.

Topics: Adult; Aged; Deamino Arginine Vasopressin; Female; Follow-Up Studies; Humans; Male; Medical Records; Middle Aged; Multiple Sclerosis; Renal Agents; Retrospective Studies; Time Factors; Urination Disorders

Topics: Circadian Rhythm; Deamino Arginine Vasopressin; Diuresis; Humans; Multiple Sclerosis

Sixteen women with multiple sclerosis who complained of nocturia completed a double-blind cross-over trial of Desmopressin (DDAVP) and placebo. Nocturia was reduced from a mean of 2.55 voids to 2.01 with placebo and to 1.28 with Desmopressin (p less than 0.01, for the difference between placebo and Desmopressin). Side effects were minor, and equally distributed between treatment and placebo.

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Double-Blind Method; Female; Humans; Multiple Sclerosis; Urination Disorders