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Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis

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A Letter to the Editor to this article was published on 30 May 2020

Abstract

Purpose

To quantitatively assess the benefit–risk ratio on the efficacy and safety of all phosphodiesterase type 5 inhibitors (PDE5i) in men with erectile dysfunction.

Methods

A systematic review with network meta-analysis, surface under the cumulative ranking analysis and stochastic multicriteria acceptability analyses were performed. Searches were conducted in Pubmed, Scopus, Web of Science without limits for time-frame or language. Randomized controlled trials evaluating the efficacy or safety of any PDE5i compared to a placebo or to other PDE5i in males with erectile disfunction were included.

Results

Overall, 184 articles representing 179 randomized controlled trials (50,620 patients) were included. All PDE5i were significantly more efficient than placebo. Sildenafil 25 mg was statistically superior to all interventions in enhancing IIEF (with a 98% probability of being the most effective treatment), followed by sildenafil 50 mg (80% of probability). Taladafil 10 mg and 20 mg also presented good profiles (73% and 76%, respectively). Avanafil and lodenafil were less effective interventions. Mirodenafil 150 mg was the treatment that caused more adverse events, especially flushing and headaches. Sildenafil 100 mg was more related to visual disorders, while vardenafil and udenafil were more prone to cause nasal congestion.

Conclusion

Sildenafil at low doses and tadalafil should be the first therapeutic options. Avanafil, lodenafil and mirodenafil use are hardly justified given the lack of expressive efficacy or high rates of adverse events.

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Acknowledgements

We thank Pedro Duarte for the help in the statistical analyses. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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Authors and Affiliations

  1. Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil

    Camilla R. Madeira, Fernanda S. Tonin, Mariana M. Fachi, Leticia P. Leonart & Aline F. Bonetti

  2. Department of Pharmacy, Federal University of Paraná, Av. Pref. Lothario Meissner, 632, Curitiba, Paraná, Brazil

    Helena H. Borba, Angela C. L. B. Trindade, Alan G. Gonçalves & Roberto Pontarolo

  3. Division of Urology, School of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil

    Vinicius L. Ferreira & Rogerio P. Moritz

  4. Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal

    Fernando Fernandez-Llimos

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Contributions

CRM: data collection, data analysis, manuscript writing. FST: project development, data analysis, manuscript writing. MMF: data collection, data analysis, manuscript writing. HHB: data collection, data analysis, manuscript editing. VLF: data collection, data analysis, manuscript editing. LPL: data collection, data analysis, manuscript editing. AFB: data collection, data analysis, manuscript editing. RPM: manuscript editing. ACLBT: project development, manuscript editing. AGG: project development, manuscript editing. FF-L: project development, data analysis, manuscript writing. RP: project development, manuscript editing.

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Correspondence to Roberto Pontarolo.

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Madeira, C.R., Tonin, F.S., Fachi, M.M. et al. Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis. World J Urol 39, 953–962 (2021). https://doi.org/10.1007/s00345-020-03233-9

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