An Internally Validated Nomogram for Predicting the Likelihood of Improvement of Clinical Global Impression in Patients with Lifelong Premature Ejaculation Treated with Dapoxetine

Abstract

Background: Although the introduction of dapoxetine has ushered in a new era in the treatment of premature ejaculation, many patients with lifelong premature ejaculation (LPE) exhibit an unimproved clinical global impression even after treatment with dapoxetine. Aim: To investigate independent predictors of the improvement of Clinical Global Impression (iCGI) in patients with LPE treated with dapoxetine and develop a nomogram to predict a patient's likelihood of achieving iCGI. Methods: Data of 243 patients with LPE diagnosed at Xijing Hospital (Xi'an, China) and Northwest Women's and Children's Hospital (Xi'an, China) from January 2019 to May 2020 were analyzed. Independent predictors of iCGI were identified, and a nomogram was developed using R software based on a multivariate logistic regression model. The predictive accuracy of the nomogram was measured using the area under the receiver operating characteristic curve. The nomogram was calibrated by comparing predictions with observations. Main Outcome Measures: The primary outcome was the patient-rated Clinical Global Impression of Change scale score after a 4-week course of dapoxetine treatment, which was collected via an online questionnaire. A Clinical Global Impression of Change score of !1 was defined as iCGI in this study. Results: Patients with LPE with at least a bachelor's degree, a self-reported intravaginal ejaculation latency time of >1 minute, and an International Index of Erectile Function question 5 score of !3 were independent factors associated with achieving iCGI, whereas a Premature Ejaculation Diagnostic Tool question 1 score of !2 was an independent factor negatively associated with achieving iCGI. The predictive accuracy of the nomogram, which was developed by integrating all variables with independent predictive significance, was 0.710 (95% confidence interval: 0.702e0.718). In addition, the calibration plot demonstrated excellent agreement between predictions and observations. Clinical Implications: If the predictive performance of our nomogram is further proven in multiple external validations, it can be used to select suitable patients for dapoxetine treatment, thereby reducing the number of patients discontinuing treatment. Strengths & Limitations: This study developed the first nomogram for predicting the likelihood of achieving iCGI in patients with LPE treated with dapoxetine. However, our nomogram was not externally validated using independent cohorts from other institutions. Conclusion: This study identified several independent predictors of iCGI in patients with LPE treated with dapoxetine. An effective nomogram was developed to predict their likelihood of achieving iCGI.

Nomogram for stratifying patients with lifelong premature ejaculation before using the PHQ‐9: An observational study

“…However, PHQ‐9 psychologically burdens several patients with LPE, which may lead to the development of LPE 9 . In the field of andrology, nomograms that predict the individual possibility of undergoing certain events have been developed 20,21 . In this study, we aim to build the first nomogram for discerning LPE patients with low risks of PHQ‐9 + , whose clinical outcomes are likely to be improved by close follow‐up rather than exposure to the PHQ‐9.…”

“…Of note, when the physical pain intensity was assessed, pains in the perineum, penis, testis and pubic area were taken into consideration. In this study, erectile function was divided into four grades according to the IIEF-5 score: without erectile dysfunction (ED) (≥22), mild ED (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), moderate ED (8)(9)(10)(11) and severe ED (5-7).…”

Construction and internal validation of a prediction nomogram for acquired premature ejaculation (APE) in PE patients

“…Nomograms, graphical representations of multivariable models, have been proven to be effective in predicting the individual chance of experiencing certain events, such as erectile function recovery after radical prostatectomy, 35 improvement of clinical global impression in LPE Patients Treated With Dapoxetine, 12 and natural conception at various time points among couples diagnosed with unexplained subfertility 36 . No nomogram has been established to predict the possibility of APE in patients with PE to our knowledge.…”

“…Diagnosis and classification of PE are mainly based on the medical and sexual histories of patients, 7 and intra‐vaginal ejaculation latency time (IELT) plays an important role in the classification of PE. Nomograms, graphical representation of multivariable prediction models, has been applied in the field of andrology and shows a good accuracy 12 . However, nomogram prediction for APE in PE patients has not yet been established to date and it may be useful to establish a nomogram to predict APE in PE patients.…”

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

“…Remarks It seems mandatory to check for the recently postulated Loss of Control of Erection and Ejaculation (LCEE) in all patients with sexual dysfunction and in particular for those referred with PE, where the ED could be hidden and non-evident to the patient himself [150]. Use of psychometry, careful clinical history and discussing the issue with the partner may help with this complex diagnosis, addressing the management which should always start with the treatment of ED or subclinical ED (SED; see below) [156][157][158][159].…”