madman
Super Moderator
Objectives
Current data suggest that all available PDE5-inhibitors (PDE5is) appear equivalent for treating erectile dysfunction (ED). We aimed to compare the effectiveness of PDE5is in terms of a novel TRIFECTA outcome, including erectile function (EF), orgasmic function (OF), and psychological well-being.
Methods
We analysed 328 ED patients assessed at a single centre in 2010-2023. Patients were prescribed with either sildenafil, tadalafil, vardenafil or avanafil on-demand at the maximum effective dose for at least 1 month and with a minimum of 6 sexual attempts. The choice of PDE5i was based on clinical judgment and patient preference. All patients completed International Index of Erectile Function (IIEF) and Becks Inventory for Depression (BDI) at baseline and follow up. The TRIFECTA outcome was defined as achieving an IIEF-EF>=26 + IIEF-OF >=8 + BDI score<11 (indicating good psychological well-being). Kaplan-Meier estimated the probability of achieving TRIFECTA over time according to different PDE5is and Cox-regression analysis tested predictors of treatment efficacy.
Results
Median (IQR) age was 55 (43-62) years. Median IIEF-EF, IIEF-OF and BDI score were 16 (8-23), 8(5-10) and 6 (2-11), with 53% (174) patients reporting moderate-severe ED and 28% (91) having depressive symptoms (BDI>11). Overall, 16% (52), 39% (127), 28% (91) and 18% (58) received sildenafil, tadalafil, vardenafil and avanafil. The median treatment duration was 8 (3-15) months. Overall, TRIFECTA was achieved in only 15% (48) of cases. Kaplan-Meier (figure) showed estimated TRIFECTA rates at 6 months of 20% (95% CI:8-45), 4% (95% CI:1-13), 12% (95% CI:5-28) and 18% (95% CI:6-46) for sildenafil, tadalafil, vardenafil and avanafil (p<0.0001). At Cox-regression tadalafil was associated with a lower probability of achieving TRIFECTA over time (HR: 0.31, p=0.009) after adjusting for baseline characteristics.
Conclusions
PDE5is on-demand for ED are associated with a low overall probability of treatment success in terms of EF, OF and psychological well-being (TRIFECTA). According to our data sildenafil, vardenafil and avanafil should be preferred over tadalafil in order to achieve a TRIFECTA in the short term.
Figure 1.
Kaplan-Meir curve depicts the probability of achieving TRIFECTA over time according to different PDE5is
Current data suggest that all available PDE5-inhibitors (PDE5is) appear equivalent for treating erectile dysfunction (ED). We aimed to compare the effectiveness of PDE5is in terms of a novel TRIFECTA outcome, including erectile function (EF), orgasmic function (OF), and psychological well-being.
Methods
We analysed 328 ED patients assessed at a single centre in 2010-2023. Patients were prescribed with either sildenafil, tadalafil, vardenafil or avanafil on-demand at the maximum effective dose for at least 1 month and with a minimum of 6 sexual attempts. The choice of PDE5i was based on clinical judgment and patient preference. All patients completed International Index of Erectile Function (IIEF) and Becks Inventory for Depression (BDI) at baseline and follow up. The TRIFECTA outcome was defined as achieving an IIEF-EF>=26 + IIEF-OF >=8 + BDI score<11 (indicating good psychological well-being). Kaplan-Meier estimated the probability of achieving TRIFECTA over time according to different PDE5is and Cox-regression analysis tested predictors of treatment efficacy.
Results
Median (IQR) age was 55 (43-62) years. Median IIEF-EF, IIEF-OF and BDI score were 16 (8-23), 8(5-10) and 6 (2-11), with 53% (174) patients reporting moderate-severe ED and 28% (91) having depressive symptoms (BDI>11). Overall, 16% (52), 39% (127), 28% (91) and 18% (58) received sildenafil, tadalafil, vardenafil and avanafil. The median treatment duration was 8 (3-15) months. Overall, TRIFECTA was achieved in only 15% (48) of cases. Kaplan-Meier (figure) showed estimated TRIFECTA rates at 6 months of 20% (95% CI:8-45), 4% (95% CI:1-13), 12% (95% CI:5-28) and 18% (95% CI:6-46) for sildenafil, tadalafil, vardenafil and avanafil (p<0.0001). At Cox-regression tadalafil was associated with a lower probability of achieving TRIFECTA over time (HR: 0.31, p=0.009) after adjusting for baseline characteristics.
Conclusions
PDE5is on-demand for ED are associated with a low overall probability of treatment success in terms of EF, OF and psychological well-being (TRIFECTA). According to our data sildenafil, vardenafil and avanafil should be preferred over tadalafil in order to achieve a TRIFECTA in the short term.
Figure 1.
Kaplan-Meir curve depicts the probability of achieving TRIFECTA over time according to different PDE5is
