Nationwide Trends in Desmopressin Prescribing for Nocturnal Polyuria in Japan: A Population-Based Analysis (2020-2023).

OBJECTIVES

Desmopressin is an established treatment for nocturia due to nocturnal polyuria. In Japan, low-dose formulations (25 and 50 μg) were approved only for men in 2019. However, age- and dose-specific prescribing patterns in real-world practice remain unclear. Using nationwide aggregated claims data, we analyzed age-stratified prescribing trends and dose selection patterns.

METHODS

Publicly available NDB Open Data (fiscal years 2020-2023) were used. Outpatient prescriptions for desmopressin orally disintegrating tablets (25 and 50 μg) were extracted by sex and 5-year age categories. Population-adjusted prescription rates per 1000 persons and 95% confidence intervals (CIs) were calculated. Temporal trends were evaluated using Poisson regression models with log-population offset.

RESULTS

In men, the population-adjusted prescription rate increased from 21.5 per 1000 persons in 2020 to 84.6 in 2023 (p for trend < 0.001). More than 90% of prescriptions were issued to individuals aged ≥ 65 years. Overall, use of the 25 and 50 μg formulations was balanced; however, the proportion of the 25 μg formulation increased with advancing age, and the 25 μg/50 μg ratio reached 1.37 among those aged ≥ 90 years. Prescriptions in women also increased, with predominance of the 25 μg formulation.

CONCLUSIONS

Desmopressin prescribing has increased nationwide in Japan, particularly among older men. Increased selection of the lower-dose formulation in older patients may reflect safety considerations. Off-label use in women is increasing, indicating the need for further safety evaluation and appropriate prescribing guidelines.