Review Gives Nod to PDE-5 Inhibitors in Men with Diabetes

By Wendling, Patrice | Clinical Psychiatry News, February 2007 | Go to article overview

Review Gives Nod to PDE-5 Inhibitors in Men with Diabetes


Wendling, Patrice, Clinical Psychiatry News


Phosphodiesterase type 5 inhibitors should be considered a primary treatment for erectile dysfunction in men with diabetes mellitus, according to a meta-analysis published recently in the online issue of the Cochrane Database of Systematic Reviews.

The review called the drugs safe and effective, stating that "their relative as well as absolute effect on sexual activity is clinically favorable, with consistent statistical significance."

The analysis revealed that their effect may wane at low doses in patients with uncontrolled diabetes, and that higher doses may be required for this particular subgroup (Cochrane Database Syst. Rev. 2007 Jan. 24 [Epub doi:10.1002/14651858.CD002187.pub3]).

Erectile dysfunction (ED) is a common complication of diabetes, with about half of diabetic men experiencing ED at least once in the course of their disease.

Different strategies have been tried to overcome this complication prior to phosphodiesterase (PDE) type 5 inhibitors, but none proved definitive.

The Cochrane reviewers analyzed eight randomized controlled trials in which 976 men received a PDE-5 inhibitor and 741 received placebo for the treatment of ED.

Overall, 80% of the participants had type 2 diabetes.

Six trials compared sildenafil (Viagra) with placebo at doses titrated between 25 mg and 100 mg. The other two trials compared tadalafil (Cialis) 10 mg and 20 mg with placebo, and vardenafil (Levitra) 10 mg and 20 mg with placebo.

Patients used the medication no more than once daily for 10 days in one study, 16 weeks in one study, and 12 weeks in the remaining trials.

Five of eight trials included scores for Index of Erectile Function (IIEF) questions 3 and 4 on frequency of penetration and maintaining an erection to complete intercourse. The weighted mean difference for the questions was 0.9 and 1.1 at the end of the study period, in favor of the intervention group.

In the seven trials that included scores for the IIEF erectile function domain, the weighted mean difference at the end of the study period was 6. …

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