Oral drug treatments of erectile dysfunction: a AFU/SFMS systematic review
Abstract
OBJECTIVES
To evaluate the efficacy and safety of oral phosphodiesterase-5 inhibitors (PDE5Is) in the treatment of erectile dysfunction (ED). Additionally, to compare various PDE5Is and assess their suitability for different patient populations.
EVIDENCE ACQUISITION
A systematic review of literature published from January 1999 to January 2023 was conducted following the PICOS criteria. We analyzed meta-analyses, randomized controlled trials, and prospective studies focusing on PDE5Is. Only studies evaluating drugs used in France (namely sildenafil, tadalafil, vardenafil, and avanafil ) were analyzed. The outcomes measured included the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and adverse event profiles. Publications addressing specific comorbidities, such as prostate cancer-related ED or lower urinary tract symptoms, were excluded.
RESULTS
Out of 87 studies were reviewed, all four drugs have similar efficacy and toxicity profiles. Sildenafil, vardenafil and avanafil have similar pharmacokinetic profiles, whereas tadalafil has a different one enabling a daily usage. Adverse events were generally mild, including headache, myalgia, backache, dyspepsia, nasopharyngitis and flushing, with the highest tolerability observed in low-dose tadalafil. No significant differences in efficacy were observed between daily and on-demand tadalafil.
CONCLUSION
PDE5Is are effective first-line treatments for ED, with similar efficacy and safety profiles. The…
How strong is the evidence?
Evidence Hub reads this as a systematic review, 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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