Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study

Abstract

IntroductionAlthough dapoxetine is the only oral pharmacologic agent approved for the treatment of premature ejaculation (PE) and is very effective, the discontinuation rate is high.AimTo assess the discontinuation rate of patients with PE and the reasons for discontinuation in real-world practice.MethodsIn total, 182 consecutive patients were enrolled. Type of PE, self-estimated intravaginal ejaculation latency time, and medical history were evaluated in all patients who also completed the erectile function domain of the International Index of Erectile Function (IIEF). Visits were scheduled 1, 3, 6, 12, and 24 months after initiation of therapy; treatment status and the reasons for discontinuation in those who did discontinue were checked. The relations of discontinuation rates were compared with various parameters and the time to discontinuation after treatment commencement.ResultsOf all patients, 9.9% continued treatment to 2 years. The cumulative discontinuation rates at 1, 3, 6, 12, and 24 months were 26.4%, 61.6%, 79.1%, 87.3%, and 90.1%, respectively. Moreover, 79.1% of all patients discontinued treatment within 6 months. After 12 months, the discontinuation rate decreased sharply. The reasons for discontinuation were cost (29.9%), disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%), side effects (11.6%), perceived poor efficacy (9.8%), a search for other treatment options (5.5%), and unknown (18.3%). Patients with acquired PE (vs lifelong PE), with intravaginal ejaculation latency time longer than 2 minutes before treatment, on phosphodiesterase type 5 inhibitors, and with IIEF erectile function scores lower than 26 tended to discontinue early and thus exhibited high dropout rates.ConclusionThe treatment discontinuation rate of dapoxetine was very high. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required.Park HJ, Park NC, Kim TN, et al. Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study. Sex Med 2017;5:e99–e105.

Vibrator-Assisted Start–Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial

“…The present study provided further evidence that behavioral methods can lead to significant reductions in PE, with a majority of the participants in the present study improving in terms of their categorization on a validated scale of PE. While the present first-line treatment of PE is associated with a range of side effects, contributing to making treatment with SSRIs unacceptable to most patients, (Jern et al, 2014;Mondaini et al, 2013;Park et al, 2017), no side effects have been reported by the vibrator-assisted start-stop exercises in the present or previous studies, besides complaints concerning difficulty to find time to complete all recommended exercises (Jern, 2014;Zamar, 2012). As for the practical administration of treatment, taking a pill is simple and quick, whereas start-stop exercises necessitate a considerable investment of time and effort.…”

“…At present, selective serotonin reuptake inhibitors (SSRIs) are considered first-line agents for treatment of PE (McMahon, 2015). However, several studies of the only drug approved for treatment of PE (dapoxetine, an SSRI to be taken on demand) in naturalistic settings have reported high discontinuation rates ranging from 70.6 to 89.6% after 12 months, with common reasons for discontinuation being low efficacy, side effects, cost, and loss of interest in sex (Jern, Johansson, Piha, Westberg, & Santtila, 2014;Mondaini et al, 2013;Park et al, 2017). This indicates that further development of treatment options for PE is warranted.…”

Premature ejaculation: challenging new and the old concepts

“…Despite the high efficacy of SSRIs and associated low rate of adverse events, the proportions of men who stopped using DPX were 79.1% within 6 months and 90.1% at 2 years 73 . The commonest reasons for discontinuation were the following:…”

“… 112 and Sato et al . 111 , where silodosin was compared with other α1-adrenoceptor antagonists 73 . Ideally, before it is possible to fully assess the efficacy of silodosin, there must be a placebo-controlled trial with a more diverse PE population using the ISSM criteria.…”

Prematür ejakülasyon tedavisinde güncel yaklaşımlar

“…[19] Uzun etkili SSRİ'lere göre yan etki profili daha iyi olmasına rağmen, dapoksetin tedavisi alan hastaların fiyat ve etkinlik sorunları nedeniyle tedaviden 3, 6, 12 ve 24 ay sonra ilacı bırakma oranları sırasıyla %61,6, %79,1, %87,3, ve %90,1 bulunmuştur. [20] Yaşam boyu PE'li olgulara göre kazanılmış PE (İVEZ ˃ 2 dakika)'li olgularda ilacı bırakma süresi daha kısa ve oranı daha yüksektir.…”