Skip to main content
Top
Published in: World Journal of Urology 6/2019

01-06-2019 | Review

Comparative efficacy and safety of phosphodiesterase type 5 inhibitors for erectile dysfunction in diabetic men: a Bayesian network meta-analysis of randomized controlled trials

Authors: Xinyang Liao, Shi Qiu, Yige Bao, Wanyu Wang, Lu Yang, Qiang Wei

Published in: World Journal of Urology | Issue 6/2019

Login to get access

Abstract

Purpose

To compare the efficacy and safety profiles of different phosphodiesterase-5 inhibitors (PDE5Is) administrations for erectile dysfunction (ED) in diabetic men, including on-demand (PRN) and regular regimens (OAD).

Materials and methods

Searches were carried out in four electronic databases: PubMed (until April 17th, 2017); Scopus (until April 17th, 2017); Embase (until April 17th, 2017); and Cochrane (until April 18th, 2017). The outcomes for this study are as follows: (1) Global Assessment Question (GAQ) positive response rate; (2) changes from baseline to the end of the study in Erectile Function Domain of International Index of Erectile Function (IIEF-EF); and (3) treatment-related adverse events (TRAEs). The comparative effects of PDE5I regimens were analyzed with random-effect models in a Bayesian Framework using the GeMTC R package.

Results

We identified 1056 records, of which 15 randomized trials with 5274 patients were included. The included studies covered eight kinds of PDE5I administration: avanafil PRN; mirodenafil PRN; sildenafil PRN; tadalafil PRN; tadalafil OAD; udenafil PRN; udenafil OAD; vardenafil PRN; and placebo. In surface under the cumulative ranking curve analysis, vardenafil PRN ranked first, third and first, and mirodenafil PRN ranked second, first and second in GAQ, IIEF-EF, and TRAEs, respectively.

Conclusions

PDE5I administrations were generally efficient and well-tolerated in diabetic men. Among these administrations, vardenafil PRN and mirodenafil PRN seem to have a possible advantage of efficacy and avoiding adverse effects compared to others. There is no significant difference between regular and on-demand regimens of PDE5Is.
Appendix
Available only for authorised users
Literature
10.
go back to reference Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH (1992) Nitric oxide: a physiologic mediator of penile erection. Science 257(5068):401–403CrossRefPubMed Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH (1992) Nitric oxide: a physiologic mediator of penile erection. Science 257(5068):401–403CrossRefPubMed
15.
go back to reference Fonseca V, Seftel A, Denne J, Fredlund P (2014) Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 47:1914–1923 [0012-186X (Print)] CrossRef Fonseca V, Seftel A, Denne J, Fredlund P (2014) Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 47:1914–1923 [0012-186X (Print)] CrossRef
16.
go back to reference Porst H, Giuliano F, Glina S, Ralph D, Casabé AR, Elion-Mboussa A, Shen W, Whitaker JS (2006) Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, Placebo-Controlled Trial. Eur Urol 50(2):351–359. https://doi.org/10.1016/j.eururo.2006.02.052 CrossRefPubMed Porst H, Giuliano F, Glina S, Ralph D, Casabé AR, Elion-Mboussa A, Shen W, Whitaker JS (2006) Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, Placebo-Controlled Trial. Eur Urol 50(2):351–359. https://​doi.​org/​10.​1016/​j.​eururo.​2006.​02.​052 CrossRefPubMed
23.
27.
go back to reference Goldstein I, Jones LA, Belkoff LH, Karlin GS, Bowden CH, Peterson CA, Trask BA, Day WW (2012) Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus. Elsevier, New York, pp 843–852 Goldstein I, Jones LA, Belkoff LH, Karlin GS, Bowden CH, Peterson CA, Trask BA, Day WW (2012) Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus. Elsevier, New York, pp 843–852
28.
go back to reference Ziegler D, Merfort F, Van Ahlen H, Yassin A, Reblin T, Neureither M (2006) ED PHARMACOTHERAPY: efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med 3(5):883–891CrossRefPubMed Ziegler D, Merfort F, Van Ahlen H, Yassin A, Reblin T, Neureither M (2006) ED PHARMACOTHERAPY: efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med 3(5):883–891CrossRefPubMed
29.
go back to reference Stuckey BG, Jadzinsky MN, Murphy LJ, Montorsi F, Kadioglu A, Fraige F, Manzano P, Deerochanawong C (2003) Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabetes Care 26(2):279–284CrossRefPubMed Stuckey BG, Jadzinsky MN, Murphy LJ, Montorsi F, Kadioglu A, Fraige F, Manzano P, Deerochanawong C (2003) Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabetes Care 26(2):279–284CrossRefPubMed
31.
go back to reference Rendell MS, Rajfer J, Wicker PA, Smith MD (1999) Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial, Sildenafil Diabetes Study Group. JAMA 281(5):421–426CrossRefPubMed Rendell MS, Rajfer J, Wicker PA, Smith MD (1999) Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial, Sildenafil Diabetes Study Group. JAMA 281(5):421–426CrossRefPubMed
34.
go back to reference Moon DG, Yang DY, Lee CH, Ahn TY, Min KS, Park K, Park JK, Kim JJ (2011) A Therapeutic confirmatory study to assess the safety and efficacy of Zydena®(Udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med 8(7):2048–2061CrossRef Moon DG, Yang DY, Lee CH, Ahn TY, Min KS, Park K, Park JK, Kim JJ (2011) A Therapeutic confirmatory study to assess the safety and efficacy of Zydena®(Udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med 8(7):2048–2061CrossRef
35.
go back to reference Ishii N, Nagao K, Fujikawa K, Tachibana T, Iwamoto Y, Kamidono S (2006) Vardenafil 20-mg demonstrated superior efficacy to 10-mg in Japanese men with diabetes mellitus suffering from erectile dysfunction. Int J Urol 13(8):1066–1072CrossRefPubMed Ishii N, Nagao K, Fujikawa K, Tachibana T, Iwamoto Y, Kamidono S (2006) Vardenafil 20-mg demonstrated superior efficacy to 10-mg in Japanese men with diabetes mellitus suffering from erectile dysfunction. Int J Urol 13(8):1066–1072CrossRefPubMed
37.
go back to reference Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T (2003) Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 26(3):777–783CrossRefPubMed Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T (2003) Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 26(3):777–783CrossRefPubMed
38.
go back to reference Escobar-Jimenez F, Grupo de Estuido Espanol sobre S (2002) Efficacy and safety of sildenafil in men with type 2 diabetes mellitus and erectile dysfunction. Med Clin (Barc) 119(4):121–124CrossRef Escobar-Jimenez F, Grupo de Estuido Espanol sobre S (2002) Efficacy and safety of sildenafil in men with type 2 diabetes mellitus and erectile dysfunction. Med Clin (Barc) 119(4):121–124CrossRef
39.
go back to reference De Tejada IS, Anglin G, Knight JR, Emmick JT (2002) Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 25(12):2159–2164CrossRef De Tejada IS, Anglin G, Knight JR, Emmick JT (2002) Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 25(12):2159–2164CrossRef
40.
go back to reference Buvat J, Van Ahlen H, Schmitt H, Chan M, Kuepfer C, Varanese L (2006) Efficacy and safety of two dosing regimens of tadalafil and patterns of sexual activity in men with diabetes mellitus and erectile dysfunction: Scheduled use vs. on demand regimen evaluation (SURE) study in 14 European countries. J Sex Med 3(3):512–520CrossRefPubMed Buvat J, Van Ahlen H, Schmitt H, Chan M, Kuepfer C, Varanese L (2006) Efficacy and safety of two dosing regimens of tadalafil and patterns of sexual activity in men with diabetes mellitus and erectile dysfunction: Scheduled use vs. on demand regimen evaluation (SURE) study in 14 European countries. J Sex Med 3(3):512–520CrossRefPubMed
44.
go back to reference Fava M, Nurnberg HG, Seidman SN, Holloway W, Nicholas S, Tseng LJ, Stecher VJ (2006) Efficacy and safety of sildenafil in men with serotonergic antidepressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 67(2):240–246CrossRefPubMed Fava M, Nurnberg HG, Seidman SN, Holloway W, Nicholas S, Tseng LJ, Stecher VJ (2006) Efficacy and safety of sildenafil in men with serotonergic antidepressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 67(2):240–246CrossRefPubMed
Metadata
Title
Comparative efficacy and safety of phosphodiesterase type 5 inhibitors for erectile dysfunction in diabetic men: a Bayesian network meta-analysis of randomized controlled trials
Authors
Xinyang Liao
Shi Qiu
Yige Bao
Wanyu Wang
Lu Yang
Qiang Wei
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 6/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-018-2583-1

Other articles of this Issue 6/2019

World Journal of Urology 6/2019 Go to the issue