Clinical Outcomes Following Supply-Driven Transition From Intranasal to Oral Desmopressin in AVP-Deficiency—A Single Centre Experience Including The Pituitary Foundation Desmopressin Shortage Impact Report

IF 2.8 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2026-06-02 Epub Date: 2026-03-12 DOI:10.1111/cen.70120

Trevor Tam, Amy Mach, Alam Wahid, Neetha Joseph, Amy Shingler, Patricia McBride, Francesca Swords, Ketan Dhatariya, Rupa Ahluwalia

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引用次数: 0

Abstract

Introduction

Arginine vasopressin deficiency (AVP-D) requires lifelong desmopressin replacement. In March 2025, the national suspension of intranasal desmopressin necessitated urgent transition to oral alternatives. However, optimal conversion ratios and clinical response remain undefined. We evaluated clinical outcomes following this supply-driven transition.

Methods

A retrospective study at a tertiary UK centre (01/01/2025–01/07/2025) identified patients with confirmed AVP-D switched from intranasal to oral desmopressin. Demographic and clinical data were collected. Conversion ratios (intranasal: oral) were calculated before and after titration.

Results

Forty two patients were included (mean age 52.6 ± 2.3; 31% male). 15/42 (35.7%) isolated AVP-D; 11/42 (26.2%) partial hypopituitarism; 16/42 (38.1%) panhypopituitarism. Median intranasal desmopressin dose pre-switch was 10 mcg/day (IQR 10–20 mcg). Initial median oral dose before titration was 200 mcg/day (IQR 100–200 mcg); final median oral dose after titration was 200 mcg/day (IQR 162.5–300 mcg). 23/42 (54.8%) were switched initially using 1:10 ratio (10 mcg intranasal desmopressin to 100 mcg oral tablet). 13/23 (56.5%) reported symptomatic recurrence, warranting further titration. The remaining 19/42 (45.2%) were switched initially using a median ratio of 1:20 (IQR 1:11.8–1:20). 10/19 (52.6%) reported symptomatic recurrence. Overall, switching from intranasal to oral desmopressin resulted in 16 patient calls, 79 additional blood tests and one hospitalisation. Similarly, the findings of The Pituitary Foundation Impact Report demonstrated that the switch led to 121/161 (75.2%) of patients reporting poorer symptomatic control post-switch, and 76/161 (47.2%) requiring additional endocrine input.

Conclusion

45.2% (19/42) of patients achieved adequate symptom control post-switch with varying conversion ratios, and over half (13/23, 56.5%) of patients switched with an initial 1:10 conversion ratio reported symptomatic recurrence. Although a higher initial conversion ratio closer to 1:15 may reduce symptomatic recurrence in some patients, initiating treatment at a 1:10 ratio with careful up-titration represents a safe and pragmatic approach that minimises the risk of over-replacement and hyponatraemia, although inter-patient variability necessitates tailored titration. In parallel, national patient-reported data from The Pituitary Foundation Impact Report demonstrate the substantial patient and clinical burden of this supply-driven switch, highlighting the need for standardised guidance and prospective studies.

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avp缺乏症从鼻内到口服去氨加压素供应驱动转变的临床结果——包括垂体基金会去氨加压素短缺影响报告的单中心经验

简介：精氨酸抗利尿激素缺乏症（AVP-D）需要终生替代去氨加压素。2025年3月，全国暂停使用鼻内去氨加压素，需要紧急过渡到口服替代品。然而，最佳转换率和临床反应仍不明确。我们评估了这种供应驱动型转变后的临床结果。方法：在英国某三级医疗中心（2025年1月1日- 2025年7月1日）进行的一项回顾性研究中，发现确诊AVP-D的患者从鼻内转为口服去氨加压素。收集了人口统计学和临床数据。计算滴定前后的转化率（鼻内：口服）。结果：纳入42例患者（平均年龄52.6±2.3岁，男性31%）。15/42（35.7%）分离AVP-D；11/42（26.2%）部分垂体功能低下；16/42（38.1%）为全垂体功能减退。转换前鼻内去氨加压素的中位剂量为10微克/天（IQR 10-20微克）。滴定前的初始中位口服剂量为200微克/天（IQR 100-200微克）；滴定后的最终中位口服剂量为200微克/天（IQR 162.5-300微克）。23/42（54.8%）患者最初使用1:10的比例（10微克鼻内降压素与100微克口服降压素）进行切换。13/23（56.5%）报告有症状复发，需要进一步滴定。剩余的19/42（45.2%）最初使用中位数比例1:20 （IQR 1:11.8-1:20）进行切换。10/19（52.6%）报告有症状复发。总体而言，从鼻内降压改为口服降压导致16名患者就诊，79次额外血液检查和1次住院。同样，垂体基金会影响报告的结果表明，转换导致121/161（75.2%）的患者报告转换后症状控制较差，76/161（47.2%）的患者需要额外的内分泌输入。结论：转换比例不同的患者中，45.2%（19/42）的患者在转换后获得了足够的症状控制，超过一半（13/23,56.5%）的转换比例为1:10的患者出现了症状复发。虽然接近1:15的较高初始转换率可能会减少一些患者的症状复发，但以1:10的比例开始治疗并小心地提高滴度是一种安全实用的方法，可以最大限度地降低过度替代和低钠血症的风险，尽管患者之间的差异需要量身定制滴度。与此同时，垂体基金会影响报告的国家患者报告数据表明，这种供应驱动的转变给患者和临床带来了巨大的负担，强调了标准化指导和前瞻性研究的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.