(360) which of PDE5 inhibitors is most effective in the treatment of erectile dysfunction in patients with spinal cord injury? a network meta-analysis
Abstract
PDE5 inhibitors (PDE5i) represent the first-line drugs in the treatment of spinal cord injury (SCI)-related erectile dysfunction (ED). Available molecules have differences that should guide personalization of treatment. We compared the efficacy of PDE5 inhibitors to define which is more effective in treating SCI-related ED.
A systematic search was performed. A traditional pairwise meta-analyses were conducted including only studies in which PDE5i were directly compared with placebo, then a network meta-analysis (NMA) was conducted. Based on the assumption of transitivity, if two treatments, A and B, have never been compared with each other but both have been compared with a third treatment (e.g., a placebo), the NMA can provide information on the A vs. B comparison by means of the statistical method of “indirect comparison”. With this approach, multiple treatments are compared within a single statistical model generating an efficacy hierarchy to drive clinical practice.
The search identified 10 trials. The most common comparison was between sildenafil and placebo. All three molecules were compared at least once with each other and with placebo. The results of the NMA confirmed a significant improvement in erectile function with each of the three molecules. At the comparative analysis, tadalafil, which was 5 times more effective than placebo, was associated with the highest surface under the cumulative ranking curve (SUCRA) value (0.81), thus proving to be the best PDE5i in…
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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.
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