- A daily low dose of a phosphodiesterase 5 inhibitor (PDE5i) can improve erectile dysfunction (ED) when standard on-demand treatment fails.
Why this matters
- On-demand PDE5i monotherapy is a first-line ED treatment, but 30%-40% of patients show little or no response, say researchers.
- Alprostadil therapy is often successful in these patients, but requires painful intracavernosal injections.
- Researchers analyzed 13 observational studies and randomized controlled trials of ED treatment in patients failing PDE5i monotherapy.
- Main outcome measures were International Index of Erectile Function (IIEF) and Erectile Function Domain (EFD) scores.
- Funding: None.
- Similar IIEF score improvements occurred with daily low-dose treatment with the PDE5i tadalafil either alone (from 10.5±5.2 to 18.3±4.5; P<.05 or in combination with sildenafil on demand to p>
- Androgen plus PDE5i was no better than PDE5i monotherapy, but appeared safe.
- More research is needed to determine the efficacy of PDE5i in combination with other drugs, such as metformin, folic acid, and 5-alpha reductase inhibitors.
- Study designs were heterogeneous and sample sizes were small.