When men consider taking phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction (ED), they often have questions. Will the drug work? If so, how effective will it be? Will there be side effects?
New research published in European Urology may help physicians answer these questions.
A team of Swiss and Dutch researchers conducted a meta-analysis of 154 trials to determine the trade-offs of different PDE5 inhibitor recommended starting doses.
Eighty-two of the trials focused on efficacy; the remaining 72 reported on adverse events. Together, the trials involved almost 68,000 patients and different dosages of seven PDE5Is: avanafil, lodenafil, mirodenafil, sildenafil, tadalafil, udenafil, and vardenafil.
Selected studies compared a PDE5 inhibitor either to a placebo or to another PDE5 inhibitor.
Overall, the PDE5 inhibitors were more effective than placebos. They were also well-tolerated, for the most part.
When considering the drugs and recommended starting doses, the researchers were able to weigh efficacy vs. adverse events.
They found that sildenafil 50 mg had the greatest efficacy, but it also had the highest rate of side effects of all the drugs studied. In contrast, tadalafil 10 mg had the lowest rate of side effects, but only “intermediate” efficacy.
Vardenafil 10 mg and avanafil 100 mg had lower efficacy with high rates of side effects. The efficacy of udenafil 100 mg was comparable to that of tadalafil 10 mg, but the drug had a higher rate of side effects.
The most common side effects were headache, flushing, indigestion, and nasal congestion.
This study was the first to consider efficacy and side effects together, the authors noted.
They acknowledged that the studies in question did not specify whether patients experienced more than one side effect. It was unclear whether one side effect could trigger a second one.
Still, their findings might help clinicians and patients weigh the pros and cons of different PDE5 inhibitors.
“Physicians should explore whether patients with ED desire immediate stronger efficacy at the cost of a higher risk of side effects, or tolerability of the drug at the cost of lower efficacy,” the authors wrote.
Chen, Liang, et al.
“Phosphodiesterase 5 Inhibitors for the Treatment of Erectile Dysfunction: A Trade-off Network Meta-analysis”
(Full-text. Published online: March 26, 2015)