Efficacy and safety of first-line therapies and first-line-based combination therapies for monosymptomatic nocturnal enuresis in children: a network meta-analysis.

In 30 seconds

This network meta-analysis compared first-line treatments and combination regimens for monosymptomatic nocturnal enuresis in children. It included 23 randomized controlled trials involving 2424 children and eight interventions. Combinations of desmopressin with anticholinergic agents were more effective for complete response than desmopressin alone; desmopressin plus oxybutynin ranked highest for overall efficacy. Some regimens also had lower relapse rates than desmopressin monotherapy. No significant differences in adverse events were detected across interventions. Certainty for the primary outcome ranged from moderate to low, so the comparative findings warrant cautious interpretation.

Key findings

• Desmopressin combined with oxybutynin, propiverine, solifenacin, or tolterodine significantly improved complete response versus desmopressin monotherapy.
• Desmopressin plus oxybutynin or tolterodine was superior to alarm monotherapy for complete response.
• Alarm therapy, desmopressin plus alarm, and desmopressin plus solifenacin had significantly lower relapse rates than desmopressin monotherapy.
• No significant differences in adverse events were found among interventions; certainty for the primary outcome was moderate to low.

Why it matters

The analysis compares commonly used first-line approaches and combination regimens, highlighting that treatment rankings may differ by outcome: complete response, relapse, and adverse events. It suggests potential efficacy advantages for some desmopressin–anticholinergic combinations, while finding no detected increase in adverse events. The low-to-moderate certainty means these comparative estimates should not be treated as definitive.

What to keep in mind

Evidence certainty for the primary outcome ranged from moderate to low, and the authors call for further high-quality trials.