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Clinician Article

Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis.



  • Chen L
  • Staubli SE
  • Schneider MP
  • Kessels AG
  • Ivic S
  • Bachmann LM, et al.
Eur Urol. 2015 Oct;68(4):674-80. doi: 10.1016/j.eururo.2015.03.031. Epub 2015 Mar 26. (Review)
PMID: 25817916
Read abstract Read evidence summary
Disciplines
  • Nephrology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 5/7

Abstract

CONTEXT: Erectile dysfunction (ED) is a major health care problem worldwide and phosphodiesterase 5 inhibitors (PDE5Is) are the pharmacological treatment of choice. However, the optimal PDE5I for ED treatment is not known.

OBJECTIVE: To investigate trade-offs between efficacy and adverse events for various PDE5Is in treating ED.

EVIDENCE ACQUISITION: A review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Medline, Scopus, reference lists of relevant articles, and systematic reviews were searched. Eligible studies were randomized controlled trials comparing at least one PDE5I for treating ED with placebo or another PDE5I.

EVIDENCE SYNTHESIS: We included 82 trials (47 626 patients) for efficacy analysis and 72 trials (20 325 patients) for adverse event analysis. In the trade-off analysis of starting dosages, sildenafil 50mg had the greatest efficacy but also had the highest rate of overall adverse events. Tadalafil 10mg had intermediate efficacy but had the lowest overall rate of all adverse events. Vardenafil 10mg and avanafil 100mg had similar overall adverse events than sildenafil 50mg but a markedly lower global efficacy. Udenafil 100mg had similar global efficacy to that of tadalafil 10mg but its overall adverse event rates were higher.

CONCLUSIONS: This is the first trade-off analysis of the different PDE5Is currently available. For individuals who prioritize high efficacy, sildenafil 50mg appears to be the treatment of choice. Men wishing to optimize tolerability should take tadalafil 10mg or switch to udenafil 100mg in the case of insufficient efficacy.

PATIENT SUMMARY: For patients with erectile dysfunction who wish to prioritize high efficacy, sildenafil 50mg appears to be the treatment of choice. Men who wish to optimize tolerability should take tadalafil 10mg or switch to udenafil 100mg in the case of insufficient efficacy.


Clinical Comments

Nephrology

This is an excellent meta-analysis on a timely subject. Especially this new way of putting together efficacy and adverse effect in a trade off meta-analysis is very useful. It reminds me of the way Consumer reports evaluate consumer products like cars. It is published in a relatively unfamiliar journal and I wish it can be brought of attention of US internists and family practionioners.

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