Comment on: “Risk of Erectile Dysfunction in Male Patients with Gout Treated with Febuxostat or Allopurinol: A Propensity Score-Matched Cohort Study”
Abstract
We read with interest the article by Tong et al. [1], which evaluated the risk of erectile dysfunction (ED) after urate lowering therapy (ULT) and favored allopurinol over febuxostat in male patients with gout via TriNetX database. Lacking consensus in current recommendations [2, 3], conclusions should be drawn with caution and would definitely influence future ULT selection for physician worldwide. We have several concerns on outcome measures, study design, coding, and confounders. First, the International Classification of Disease (ICD)10 of ED (N52) applied in the study was incapable of distinction of ED classification. In a retrospective cohort study [4] from the National Health Insurance Research Database (NHIRD) in Taiwan follow-up for 8 years, higher rates of atrial fibrillation were observed in impotence of organic origin ED (ICD-9-CM code 607.84) than those in psychosexual dysfunction (ICD-9-CM code 302.72) ED, indicating the role of endothelial dysfunction in disease pathophysiology. Subgroup analysis by ICD coding classification with organic ED and psychogenic ED accordingly would better interpret the statistical results. A disparate definition of “incident [5], new onset [6], and subsequent [7]”, contrary to “recurrent and persistent” ED [8], probably represented identical phenotype, is pending for further clarification and unification. As the main diagnostic endpoint of interest, the present study did not elaborate whether precise ED coding was conducted by…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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