A comparative evaluation of phosphodiesterase-5 inhibitors in erectile dysfunction treatment: a systematic review and network meta-analysis of double-blinded, placebo-controlled, randomized trials
Abstract
Abstract Objectives Erectile dysfunction (ED) is a multifaceted condition with underlying psychogenic, neurogenic, vascular, and hormonal factors, affecting 10–48% of global male population. The European Medicine Agency (EMA) has approved four phosphodiesterase-5 inhibitors (PDE5is), primarily sildenafil, tadalafil, vardenafil, and avanafil in different dosage forms, as the treatment for men with ED. This study aimed to establish a comparative efficacy and safety profile of the four PDE5is for treating men with ED. Methods A comprehensive search was performed in PubMed-Medline, EMBASE, Scopus, Cochrane CENTRAL, and other databases to identify randomized, double-blinded, placebo-controlled trials on the management of ED with PDE5is. Studies reporting changes from baseline using International Index of Erectile Function (IIEF) domains, Global Assessment Question (GAQ)/Global Efficacy Questions (GEQ), and Sexual Encounter Profile (SEP) questionnaires were prioritized. Only on-demand dosages were selected for network meta-analysis (NMA), and the primary outcomes considered were 1) the proportion of participants achieving satisfactory erectile function (EF), defined as an IIEF–EF domain score > 26 and 2) the proportion of participants achieving no ED status, based on either the IIEF–EF domain or relevant questions from the GAQ, GEQ, or SEP 2 and 3.The risk of bias of the included studies was performed using the Cochrane Risk of Bias tool. Results The NMA included 83…
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