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

Liang Chen; Sergej E L Staubli; Marc P Schneider; Alfons G Kessels; Sandra Ivic; Lucas M Bachmann; Thomas M Kessler

doi:10.1016/j.eururo.2015.03.031

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

Eur Urol. 2015 Oct;68(4):674-80. doi: 10.1016/j.eururo.2015.03.031. Epub 2015 Mar 26.

Authors

Liang Chen¹, Sergej E L Staubli¹, Marc P Schneider², Alfons G Kessels³, Sandra Ivic⁴, Lucas M Bachmann⁴, Thomas M Kessler⁵

Affiliations

¹ Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
² Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; Brain Research Institute, University of Zürich, Zürich, Switzerland; Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
³ Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
⁴ Medignition Research Consultants, Zürich, Switzerland.
⁵ Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.

PMID: 25817916
DOI: 10.1016/j.eururo.2015.03.031

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.

Keywords: Erectile dysfunction; Network meta-analysis; Phosphodiesterase 5 inhibitors.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Drug Dosage Calculations
Drug Substitution
Erectile Dysfunction / drug therapy*
Erectile Dysfunction / enzymology
Erectile Dysfunction / physiopathology
Humans
Male
Penile Erection / drug effects*
Phosphodiesterase 5 Inhibitors / administration & dosage*
Phosphodiesterase 5 Inhibitors / adverse effects
Recovery of Function
Risk Factors
Treatment Outcome

Substances

Phosphodiesterase 5 Inhibitors