Daily low-dose PDE5i can improve ED when on-demand treatment fails

  • Munk NE & al.
  • Sex Med Rev
  • 30 Jan 2019

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Study designs were heterogeneous and sample sizes were small.

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