Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis

Abstract

AimsErectile dysfunction (ED) is a major care problem worldwide. Tadalafil and sildenafil are the two most common phosphodiesterase 5 inhibitors used to treat ED. This systematic review and meta-analysis were conducted to directly compare tadalafil with sildenafil for the treatment of ED.MethodsWe designed a strategy for searching the PubMed, Embase, EBSCO, Web of Science and Cochrane library databases; the reference lists of the retrieved studies were also investigated. A literature review was performed to identify all published randomized or non-randomized controlled trials that compared tadalafil with sildenafil for the treatment of ED and to assess the quality of the studies. Two investigators independently and blindly screened the studies for inclusion. The meta-analysis was performed using RevMan 5.0.ResultsA total of 16 trials that compared tadalafil with sildenafil for the treatment of ED were included in the meta-analysis. In the meta-analysis, tadalafil and sildenafil appeared to have similar efficacies and overall adverse event rates. However, compared with sildenafil, tadalafil significantly improved psychological outcomes. Furthermore, the patients and their partners preferred tadalafil over sildenafil, and no significant difference was found in the adherence and persistence rates between tadalafil and sildenafil. Additionally, the myalgia and back pain rates were higher and the flushing rate was lower with tadalafil than with sildenafil.ConclusionTadalafil shares a similar efficacy and safety with sildenafil and significantly improves patients’ sexual confidence. Furthermore, patients and their partners prefer tadalafil to sildenafil. Hence, tadalafil may be a better choice for ED treatment.

Icariin improves SHR erectile function via inhibiting eNOS uncoupling

“…Hypertension inhibits NO production by inhibiting the expression and phosphorylation of eNOS in corpus cavernosum tissue and finally results in ED (Li, Youn, & Cai, ). Phosphodiesterase 5 inhibitor (PDE5I), targeting the NO/cGMP signalling pathway, has become the first‐line drug for the treatment of ED including those caused by hypertension, with an effective rate of 60%–70% (Gong et al, ; Sommer & Engelmann, ). Some patients had poor results, and the erectile function could not be maintained in most patients after PDE5I withdrawal.…”

Tadalafil: 15 years' journey in male erectile dysfunction and beyond

“…Tadalafil significantly improved psychological outcomes. Furthermore, the patients and their partners preferred tadalafil over sildenafil, and no significant difference was found in the adherence and persistence rates between tadalafil and sildenafil (Gong et al, ). Despite sildenafil was the first in the PDE5 inhibitors family to offer a new approach in the field of treating ED, tadalafil seems to introduce new perspectives for the treatment and cure of ED.…”

Should All Men with Type 2 Diabetes Be Routinely Prescribed a Phosphodiesterase Type 5 Inhibitor?

“…NICE advice is that men with T2DM and ED should be offered "a PDE5 inhibitor with the lowest acquisition cost", which is sildenafil 25 mg and "4 tablets per month maximum" [3]. Multiple randomized controlled trials (RCTs) have shown that, at best 50% of patients succeed with "ondemand" PDE5 inhibitors even at the highest dose and with unrestricted medication [13]. The mechanism of ED in T2DM is predominantly endothelial dysfunction, a chronic pathology affecting the entire cardiovascular symptom, such that a single tablet of sildenafil with a half-life of 4 hours is unlikely to affect the underlying progressive pathological process.…”

“…The multiple pathologies involved in ED in T2DM are outlined in Table 1. Effectively Roger was unlikely to achieve success [13].…”