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

Autor: Madeira CR; Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil., Tonin FS; Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil., Fachi MM; Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil., Borba HH; Department of Pharmacy, Federal University of Paraná, Av. Pref. Lothario Meissner, 632, Curitiba, Paraná, Brazil., Ferreira VL; Division of Urology, School of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Leonart LP; Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil., Bonetti AF; Pharmaceutical Sciences Postgraduate Programme, Federal University of Paraná, Curitiba, Brazil., Moritz RP; Division of Urology, School of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil., Trindade ACLB; Department of Pharmacy, Federal University of Paraná, Av. Pref. Lothario Meissner, 632, Curitiba, Paraná, Brazil., Gonçalves AG; Department of Pharmacy, Federal University of Paraná, Av. Pref. Lothario Meissner, 632, Curitiba, Paraná, Brazil., Fernandez-Llimos F; Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal., Pontarolo R; Department of Pharmacy, Federal University of Paraná, Av. Pref. Lothario Meissner, 632, Curitiba, Paraná, Brazil. pontarolo@ufpr.br.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2021 Mar; Vol. 39 (3), pp. 953-962. Date of Electronic Publication: 2020 May 09.
DOI: 10.1007/s00345-020-03233-9
Abstrakt: 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.
Databáze: MEDLINE
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