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Everaert K, Holm-Larsen T, Bou Kheir G, Rottey S, Weiss JP, Vande Walle J, Kabarriti AE, Dossche L, Hervé F, Spinoit AF, Nørgaard JP, Juul KV. Potential clinical applications of current and future oral forms of desmopressin (Review). Exp Ther Med 2024; 28:303. [PMID: 38873038 PMCID: PMC11170333 DOI: 10.3892/etm.2024.12592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/06/2024] [Indexed: 06/15/2024] Open
Abstract
Desmopressin is a synthetic analogue of vasopressin and a selective vasopressin receptor 2 agonist. It was first synthesised in 1967 and utilised for its antidiuretic properties. It is also used in bleeding disorders to enhance clotting. Other potential uses of the drug have been reported. The present review aims to provide a broad overview of the literature on potential further uses of oral forms of desmopressin. Key therapeutic areas of interest were identified based on known physiological activities/targets of desmopressin or reports of an effect of desmopressin in the literature. The feasibility of adequate dosing with oral forms of the drug was also considered. Systematic literature searches were carried out using the silvi.ai software for the identified areas, and summaries of available papers were included in tables and discussed. The results of the searches showed that desmopressin has been investigated for its efficacy in a number of areas, including bleeding control, renal colic, the central nervous system and oncology. Evidence suggests that oral desmopressin may have the potential to be of clinical benefit for renal colic and bleeding control in particular. However, further research is needed to clarify its effect in these areas, including randomised controlled studies and studies specifically of oral formulations (and doses). Further research may also yield findings for cancer, cognition and overactive bladder.
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Affiliation(s)
- Karel Everaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, 9000 Ghent, Belgium
| | - Tove Holm-Larsen
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University Hospital, 9000 Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Sylvie Rottey
- Drug Research Unit and Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jeffrey P. Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, New York City, NY 11203, USA
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Abdo E. Kabarriti
- Department of Urology, State University of New York Downstate Health Sciences University, New York City, NY 11203, USA
| | - Lien Dossche
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Pediatric & Reconstructive Urology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jens Peter Nørgaard
- Research & Development, Ferring Pharmaceuticals A/S, Ferring International PharmaScience Center, 2770 Copenhagen, Denmark
| | - Kristian Vinter Juul
- Research & Development, Ferring Pharmaceuticals A/S, Ferring International PharmaScience Center, 2770 Copenhagen, Denmark
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Boblewska J, Dybowski B. Methodology and findings of randomized clinical trials on pharmacologic and non-pharmacologic interventions to treat renal colic pain - a review. Cent European J Urol 2023; 76:212-226. [PMID: 38045783 PMCID: PMC10690388 DOI: 10.5173/ceju.2023.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Renal colic pain is considered one of the most excruciating pains ever experienced and ranks as one of the most common urological emergencies. Despite existing established recommendations, new therapies and their combinations are continuously being tested. The aim of this systematic review is to analyze and compare studies involving pharmacologic and non-pharmacologic interventions used in the treatment of renal colic pain. Material and methods This systematic review was conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Scopus, Cochrane Library, and Google Scholar were searched for relevant randomized controlled trials (RCTs) involving adult patients. The quality and results of the included studies were assessed and discussed. Results This review provides an extensive analysis of 71 identified RCTs. Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and dipyrone/metamizole have demonstrated effectiveness as single medications. Some evidence points to opioids having a potential disadvantage compared to others when used as a first-line single medication. Among the 63 studies exploring pharmacological therapy, 51 reported opioids utilization for rescue therapy in significant proportion of patients. Promising combination therapies involve the administration of an NSAID alongside opioids, ketamine, desmopressin, steroids, or nitric oxide. Conversely, spasmolytics, magnesium, and lidocaine exhibited limited or no additional effect. Noteworthy methodological shortcomings encompass a low pain threshold during participant recruitment and the reliance on pain reduction rather than complete pain elimination as an endpoint. Conclusions Frequent use of opioids as rescue medications in RCTs undermine their conclusions on effectiness of other therapeutics. Combination therapies should be considered as first choice in renal colic pain management. RCTs should define success of therapy as achieving complete or near-complete pain relief rather than pain reduction.
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Affiliation(s)
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
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Jalili M, Entezari P, Doosti-Irani A, Masoomi R, Mirfazaelian H. Desmopressin effectiveness in renal colic pain management: Systematic review and meta-analysis. Am J Emerg Med 2016; 34:1535-41. [PMID: 27289437 DOI: 10.1016/j.ajem.2016.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This meta-analysis of trials was conducted to evaluate the impact of desmopressin on renal colic pain relief in comparison to more typically used medications (opioids and nonsteroidal anti-inflammatory drugs [NSAIDs]). METHODS PubMed, EMbase, Scopus, CINHAL, and Cochrane Central Register of Controlled Trials were searched for clinical trials. Pain reduction and need for rescue treatment were the outcomes of interest. RESULTS Ten studies met our inclusion criteria and were analyzed. Pooling of data showed that, on a scale of 1-10, pain reduction after 30 minutes was significantly higher in NSAID in comparison to desmopressin (3.39 with a 95% confidence interval [CI] of 4.62-2.16; P<.01), but this reduction was not significantly different between NSAID and desmopressin-NSAID combination (-0.28 with 95% CI of -0.62 to 0.05; P=.01). Summary of relative risk (RR) for the need for rescue treatment in desmopressin in comparison to NSAID was 0.31 with a 95% CI of 0.13-0.74 and a significant RR (P<.04), but no difference was shown in desmopressin-NSAID combination in comparison to NSAID (0.70 with a 95% CI of 0.49-1.00; P<.19). On this outcome, desmopressin in comparison to opioid showed insignificant RR (1.82 with a 95% CI of 0.36-4.34; P=.72), but this need in desmopressin in comparison to desmopressin-opioid combination was 0.75 with a 95% CI of 0.56-0.99 and a significant RR (P=.042). CONCLUSION In conclusion, the results of this systematic review suggest that, according to the present low-quality studies, desmopressin can be used as an adjuvant therapy in renal colic management in combination with opioids.
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Affiliation(s)
- Mohammad Jalili
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Entezari
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Masoomi
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Emergency Medicine Research Center, Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Pricop C, Branisteanu DD, Orsolya M, Puia D, Matei A, Checherita IA. Sublingual desmopressin is efficient and safe in the therapy of lithiasic renal colic. Int Urol Nephrol 2015; 48:183-9. [PMID: 26676309 DOI: 10.1007/s11255-015-1173-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/24/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the effects of newer sublingual desmopressin administration in lithiasic renal colic, alone or combined with a nonsteroidal anti-inflammatory drug (NSAID). METHODS Prospective single-blind study including an initial number of 249 patients with lithiasic renal colic was randomized as follows: group NSAID (71 patients) received ketorolac tromethamine (ketorolac) 30 mg im and sublingual placebo (vitamin C), groups D1 and D2 (57 and 62 patients) received sublingual desmopressin (Minirin Melt), 60 and 120 μg, respectively, whereas group C (59 patients) received a combination of 30 mg im ketorolac and 60 μg sublingual desmopressin. Pain intensity was assessed using the visual analogue scale before and thirty minutes after drug administration. Patients experiencing pain aggravation were rescued and excluded from the study. RESULTS Dropout incidence was higher in the NSAID group than in the groups treated with desmopressin in monotherapy or combined with ketorolac (p < 0.05). Pain intensity was diminished at least as potently by the monotherapy with desmopressin and ketorolac. The higher dose of desmopressin and the combination therapy decreased pain intensity with 56 and 59%, respectively, significantly more than the 47% decrease obtained with ketorolac alone (p < 0.05 and p < 0.001). Mean pain decrease was higher in the combination group (C) than in the NSAID or D1 groups (p < 0.001 and p < 0.05, respectively), suggesting drug additivity. Patients did not experience severe side effects. CONCLUSIONS Sublingual desmopressin is at least as potent as NSAID in the treatment of lithiasic renal colic. The combination of sublingual desmopressin and NSAID has additive analgesic effects.
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Affiliation(s)
- Catalin Pricop
- Department of Urology, "Gr. T. Popa" University of Medicine and Pharmacy Iasi, 16th Universitatii St, 700115, Iasi, Romania
| | - Dumitru D Branisteanu
- Department of Endocrinology, "Gr. T. Popa" University of Medicine and Pharmacy Iasi, 16th Universitatii St, 700115, Iasi, Romania
| | - Martha Orsolya
- Department of Urology, Tg. Mures University of Medicine and Pharmacy, 38th Gheorghe Marinescu St, 540139, Tg Mures, Romania.
| | - Dragos Puia
- Department of Urology, "C.I. Parhon" Clinical Hospital, 50th Carol Bd., 700503, Iasi, Romania
| | - Anca Matei
- Department of Endocrinology, "St. Spiridon" Emergency Hospital, 1st Independentei Bd., 700106, Iasi, Romania
| | - Ionel Alexandru Checherita
- Department of Nephrology and Dialysis, Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy Bucharest, 37th Dionisie Lupu St, Sector 1, 020022, Bucharest, Romania
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Shirazi M, Salehipour M, Afrasiabi MA, Aminsharifi A. Analgesic Effects and Safety of Desmopressin, Tramadol and Indomethacin in Patients with Acute Renal Colic; A Randomized Clinical Trial. Bull Emerg Trauma 2015; 3:41-45. [PMID: 27162901 PMCID: PMC4771265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/10/2015] [Accepted: 03/14/2015] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To compare the efficacy of desmopressin (DDAVP), tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis. METHODS This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including 120 patients (70 men and 50 women, mean age 38.2±5.8 years) referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment. The patients were randomly assigned to three groups: group A received tramadol 50mg intramuscularly (n=40), group B received desmopressin 40 µg intranasally (n=40) and group C received indomethacin 100mg rectally (n=40). The pain was assessed both on admission and 30 minutes after the intervention. The pain intensity and the side effects were compared between two study groups. RESULTS There was no significant difference between two study groups regarding the baseline characteristics. The intensity of pain of presentation was almost similar in all groups. In group A, 30 patients (75%), in group B, 15 patients (37.5%) and in group C, 19 patients (47.5%) had complete pain relief. The pain intensity decreased significantly after the intervention within all three groups (p<0.001). CONCLUSION According to the results of the current study, rectal indomethacin, intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Tramadol was the most effective agent in controlling the pain.
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Affiliation(s)
- Mehdi Shirazi
- Department of Urology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Salehipour
- Department of Urology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Aminsharifi
- Department of Urology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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