Nutraceutical interventions for erectile dysfunction: a systematic review and network meta-analysis
Abstract
Although nutraceutical-based treatments are often provided for erectile dysfunction (ED), their efficacy remains doubtful, and the choice of one preparation over the other is challenged by the dearth of head-to-head comparative studies. We compared the efficacy of available nutraceutical interventions, alone or in combination with phosphodiesterase type 5 inhibitors (PDE5i), in improving erectile function in men with ED through a network meta-analysis (NMA), considering direct and indirect evidence into one model thus generating a hierarchy of effectiveness.
Several databases were searched for RCTs assessing the effect of any nutraceutical administration in improving erectile function when compared to each other, placebo, and/or PDE5i in men with ED. Data were included in a random-effects NMA, where medicaments effect was rated by surface under the cumulative ranking curve (SUCRA). Two NMAs were also carried out separately for organic and non-organic ED. Reciprocal comparisons between all therapy were assessed by league tables.
The main outcome was the standardized mean difference in the score of the International Index of Erectile Function IIEF-5 or IIEF-6. Fifteen RCTs yielded information on 1000 men with ED. In the overall NMA, compared to placebo, the combination propionyl L-carnitine (PLC) + acetyl L-carnitine (ALC) + Sildenafil was associated with the highest SUCRA (97%) in improving erectile function score, followed by L-Arginine + Tadalafil (84%), Sildenafil (79%),…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. 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: 1,000 participants or records.
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