NICE QUALITY STANDARD RECOMMENDATIONS REGARDING TREATMENT OPTIONS (NICE 2014)
The National Institute for Health and Care Excellence (NICE) quality standard recommendations on bedwetting in children and young people cover assessment and management of nocturnal enuresis, including recommendations on initial therapy:1
The statements in this quality standard apply to children and young people aged 5 to 18 years. Children are generally expected to be dry by a developmental age of 5 years. It is important that children aged 5 to 7 years are not excluded from the management of bedwetting on the basis of age alone, and therefore this quality standard addresses the needs of these younger children alongside older children and young people.1
Children and young people with bedwetting that hasn’t improved after changing their daily routine (and their parents or carers if appropriate) discuss possible treatment (such as a bedwetting alarm or medication) with their healthcare professional.
The choice of initial treatment should be informed by the comprehensive initial assessment, and should take into account the preference of the child or young person and, if appropriate, their parents or carers. Factors such as age, associated functional difficulties and disabilities, financial burdens and living situations may affect their preferences.1
Children and young people whose bedwetting has not responded to courses of initial treatments are referred for a specialist review.1
NICE have developed a guideline for desmopressin treatment for bedwetting in children and young people:2
Children aged <12 years have a statistically significant preference for the melt formulation vs. tablet of desmopressin.3 The melt formulation is for sublingual use, for people who have primary nocturnal enuresis.4 The dose is 120 micrograms at bedtime administered and only if needed should the dose be increased to 240 micrograms.4 The need for continued treatment should be reassessed after three months by means of a period of at least one week without DesmoMelt.4
NOTES ON GUIDELINES
Studies have compared desmopressin treatment with alarm therapy in children. Based on patients who completed a 6-month treatment, success was achieved in 76.8% and 61.8% of children in the desmopressin and alarm groups, respectively.5 At 12 months, 77.8% of desmopressin patients and 75% of alarm patients had success. Long-term success rate was significantly higher with desmopressin melt vs. alarm (68.8% vs. 46.2% [p=0.006]; intention to treat analysis).5
While it has been shown that desmopressin and use of an alarm show comparable efficacy in the treatment of primary nocturnal enuresis, drop-out rates from children using the alarm group can be high, indicating the importance of considering family motivation before selecting treatment, to ensure optimal outcome.6
The NICE Approach provides a summary of the NICE clinical guidelines for the assessment and management of NE. Download the summary to find out more.
Prescribing Information and Adverse Event Reporting
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Ferring Pharmaceuticals Ltd.
Tel: 0844 931 0050, Email: firstname.lastname@example.org