Drugs Showing Real-World Efficacy for Nocturia in Patients With Bladder Storage Symptoms - Beyond the Abstract

Nocturia is defined as the symptom that an individual has to disrupt their sleep at night, one or several times, in order to void. Nocturia is a bothersome event that markedly reduces a patient’s quality of life. The aim of the study was to elucidate which drugs, prescribed to reduce nocturia, show real-world efficacy in patients with bladder storage symptoms.

One hundred consecutive patients who visited the Fukuoka University Medical Center were evaluated between May and July 2022. Anticholinergic drugs, β3 adrenoceptor agonists, α1 blockers, desmopressin, and other medicines were prescribed for relieving nocturia. Desmopressin was used as second-line treatment of nocturia only in males with nocturnal polyuria. The primary outcome of the present study was to identify which drugs had real-world effectiveness in reducing nocturia in patients with bladder storage symptoms. We, therefore, investigated the association between each drug and decrease in the number of nocturia episodes. The secondary outcome was the association between patient characteristics and change in the number of nocturia episodes. All values are presented as mean±standard deviation. A two-sided Mann-Whitney U-test was used to determine the significance of differences in the number of nocturia episodes. Correlations between continuous variables were investigated by simple regression analysis using the square of Pearson’s correlation coefficient. Multivariate analyses were performed using multiple linear regression to identify the pharmacological agents associated with decreases in nocturnal frequency. Values of p<0.05 were considered significant. Analysis was performed using JMP version 11.0 software (SAS, Cary, NC, USA).

The number of nocturia episodes was reduced in patients using anticholinergic drugs, β3 adrenoceptor agonists, and desmopressin (−1.4±0.9, −1.3±0.9, −2.0 ±0.8 episodes/night, respectively). Multivariate analysis for the entire cohort showed that anticholinergic drugs and β3 adrenoceptor agonists were associated with significantly decreased nocturia episodes (p=0.01 and p=0.04, respectively). In males, only desmopressin was associated with a significant decrease in nocturia (p=0.03), and combination therapy significantly decreased the number of nocturia episodes compared to monotherapy (p=0.001).

In a real-world clinical setting, anticholinergic drugs and β3 adrenoceptor agonists were similarly effective in reducing nocturia. Administration of desmopressin combined with anticholinergic drugs and/or β3 adrenoceptor agonists is the most effective method for reducing nocturia in male patients with both storage symptoms and nocturnal polyuria.

Written by: Nobuhiro Haga, MD, Department of Urology, Fukuoka University, Fukuoka, Japan

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