In a nutshell
This review compared the outcomes of different combined therapy for erectile dysfunction (ED). Researchers suggested that a combination of phosphodiesterase 5 inhibitor (PDE5i) and antioxidants is safe and associated with improved outcomes in these patients.
ED consists of the inability of getting and maintaining an erection firm enough for sex. PDE5is such as sildenafil (Viagra) and tadalafil (Cialis) are recommended as first-line therapy for ED. Other recommended therapies are intracavernosal injections (injections into the penis), alprostadil (Muse) penis suppositories, vacuum erectile devices, and low-intensity shockwave therapy (LSWT). Prior studies showed that these recommended therapies provide initial positive outcomes. However, more than half of the patients have reported dissatisfaction, low adherence, and a high level of dropouts due to lack of effectiveness.
A combination of 2 or more first-line treatments for ED might be recommended before considering a penile prosthesis implant, even at the cost of increased side effects. These implants consist of devices placed inside the penis to allow men with ED to get an erection.
To date, no prior studies are comparing the effectiveness and safety of different ED treatment combinations as first-line therapy.
Methods & findings
This study reviewed 44 other studies including information about 3853 male patients with ED. Most participants received either PDE5is combined with another therapy or PDE5is alone. The main outcome measured was the change in ED symptoms between the start and end of the treatment. These changes were measured through ED symptoms questionnaires filled by the patients. The number of side effects was also measured.
Combined treatments involving PDE5is were associated with improved outcomes when compared to PDE5is alone. Combinations of PDE5is and testosterone or antioxidants were associated with improved ED symptoms. PDE5is and daily tadalafil, LSWT, vacuum erectile device, folic acid, metformin (Glucophage), and angiotensin-converting enzyme inhibitors (ACEI; blood pressure-lowering medications) combinations were also associated with improved ED symptoms. Alpha-blockers or pentoxifylline (Trental) added to PDE5i therapy did not improve ED symptoms.
In patients with ED caused by hypogonadism (low testosterone levels), including patients who previously had prostate removal surgery or were resistant to PDE5i therapy alone, combination therapy significantly improved sexual function.
The number of side effects was similar between combined therapy and PDE5is alone.
The bottom line
This study concluded that combined PDE5i therapy improved the outcomes of patients with ED, with manageable side effects.
The fine print
The severity of ED varied among studies, as well as follow-up periods. Therefore, long-term outcomes and the effectiveness based on ED severity could not be drawn. Further studies are needed.
Published By :
JAMA network open
Feb 01, 2021
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