Addressing unmet needs for patients with erectile dysfunction: a narrative review of topical therapies
Abstract
Background: Treatment of patients with erectile dysfunction (ED) was revolutionized by the development and approval of phosphodiesterase type 5 inhibitors (PDE5is), which have been repeatedly shown to be safe and effective in men with this condition. However, some patients do not respond to these agents and others may prefer an alternative therapy.
Aim: The objective of this paper is to evaluate topical therapies for ED used in clinical studies, either as single agents or in combination with a PDE5i, and consequently determine which topical therapies meet the criteria of an 'ideal medication for ED.'
Methods: The PubMed database was searched to identify clinical studies of topical agents that have been evaluated in men with ED. This review was supplemented by a search of presentations at the 2024 annual meetings of the American Urological Association and Sexual Medicine Society of North America.
Results: The literature review and subsequent screening resulted in 39 clinical studies and 5 meeting abstracts for review. The studies demonstrated efficacy for intraurethral and topical alprostadil, topical prostaglandin E1 ethyl ester, nitric oxide donors, testosterone (in selected patients), and a non-medicated hydro-alcoholic gel. The studies reviewed also demonstrated a significant benefit of adding topical alprostadil to therapy in patients with inadequate responses to PDE5is. An effective topical therapy delivered to its site of action with a rapid onset could improve…
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