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Evidence Summary

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In men with erectile dysfunction, starting doses of all assessed drugs improve symptoms and have side effects

Chen L, Staubli SE, Schneider MP, et al. Phosphodiesterase 5 Inhibitors for the Treatment of Erectile Dysfunction: A Trade-off Network Meta-analysis. Eur Urol. 2015;68:674-80.

Review questions

Which drugs are effective for erectile dysfunction? Do they have side effects?

Background

Erectile dysfunction is the inability to keep an erection firm enough for sex. About half of men 40 to 70 years of age have erectile dysfunction, and it can reduce their quality of life.

7 drugs (avanafil, lodenafil, mirodenafil, sildenafil, tadalafil, udenafil, and vardenafil) are typically used to treat erectile dysfunction.

How the review was done

The researchers did a systematic review based on studies available up to January 2013.

They found 82 randomized controlled trials that studied the effectiveness of drugs (47,626 men) and 72 randomized controlled trials that studied the side effects of drugs (20,325 men).

Drugs were compared with placebo or another drug.

What the researchers found

Compared with placebo, starting doses of:

  • sildenafil improved symptoms by 47% but increased risk of side effects by 18%;
  • vardenafil improved symptoms by 35% but increased risk of side effects by 18%;
  • lodenafil improved symptoms by 35% ( no side effect data were available);
  • udenafil and tadalafil improved symptoms by 33% but increased risk of side effects by 11% (udenafil) or 10% (tadalafil);
  • avanafil improved symptoms by 29% but increased the risk of side effects by¬† 18%; and
  • mirodenafil improved symptoms by 26% but increased risk of side effects by 16%.

Conclusion

In men with erectile dysfunction, starting doses of all assessed drugs improve symptoms and have side effects.

Effects and side effects of drugs for erectile dysfunction

Drug name

Starting drug dose

Improvement in erectile dysfunction symptoms compared with placebo

Side effects compared with placebo

Sildenafil

50 mg

47% greater improvement, but it could be as low as 34% or as high as 59%

18% more side effects, but it could be as high as 19%

Vardenafil

10 mg

35% greater improvement, but it could be as low as 32% or as high as 38%

18% more side effects, but it could be as high as 19%

Lodenafil

80 mg

35% greater improvement, but it could be as low as 17% or as high as 53%

No data available

Udenafil

100 mg

33% greater improvement, but it could be as low as 20% or as high as 47%

11% more side effects, but it could be as low as 10% or as high as 13%

Tadalafil

10 mg

33% greater improvement, but it could be as low as 26% or as high as 40%

10% more side effects, but it could be as low as 8% or as high as 12%

Avanafil

100 mg

29% greater improvement, but it could be as low as 15% or as high as 44%

18% more side effects, but it could be as low as 17% or as high as 19%

Mirodenafil

50 mg

26% greater improvement, but it could be as low as 5% or as high as 47%

16% more side effects, but it could be as low as 13% or as high as 19%

 




Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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