Comparative efficacy and safety of phosphodiesterase-5 inhibitors with selective serotonin reuptake inhibitors in men with premature ejaculation: A systematic review and Bayesian network meta-analysis
Abstract
Background: We performed the network meta-analysis (NMA) and systematic review involved all evidence from relevant trials to compare the efficiency and safety of various types of selective serotonin reuptake inhibitors (SSRI) and phosphodiesterase-5 inhibitors (PDE5i) in patients with premature ejaculation (PE).Methods: We conducted comprehensive searches of peer-reviewed and grey literature.PubMed, the Cochrane Library Central Register of Controlled Trials, Embase were searched for randomized controlled trials published up to June 1, 2017.The primary outcome was intravaginal ejaculation latency time (IVELT) and adverse effects (AEs).We performed pairwise meta-analyses by random effects model and network meta-analysis by Bayesian model.We used the GRADE framework to assess the quality of evidence contributing to each network estimate.Results: Of 3046 titles and abstracts initially identified, 17 trials reporting 5739 participants were included.Considering IVELT in the NMA, paroxetine plus sildenafil and sildenafil alone are both superior to placebo (MD: 1.75, 95% CrI: 0.05 to 3.78; MD 1.43, 95% CrI 0.003 to 2.81).Sildenafil is superior to sertraline (MD: 1.63, 95% CrI: 0.10 to 2.79).Considering AEs, placebo demonstrated obviously lower risk comparing to paroxetine, sildenafil and paroxetine plus sildenafil (OR 0.20, 95% CI: 0.05 to 0.52; OR 0.23, 95% CI: 0.04 to 0.80; OR 0.45, 95% CI: 0.01 to 0.92).Compared with tadalafil plus paroxetine, dapoxetine showed significantly less…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,739 participants or records.
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