Effect of phosphodiesterase-type 5 inhibitors on erectile function: an overview of systematic reviews and meta-analyses

Abstract

IntroductionPhosphodiesterase-type 5 inhibitors (PDE5i) are the recommended first-line treatment for erectile dysfunction. Previous systematic reviews and meta-analyses suggest that they are a safe and effective option in many patient groups. Similarly, PDE5i may be effective as part of combination therapy in non-responders to PDE5i. We will generate an overview of systematic reviews, meta-analyses and network meta-analyses aiming to summarise the available knowledge regarding the efficacy and safety of PDE5i in the general population and in multiple subgroups of patients.Methods and analysisThis overview was designed in accordance with the PRIO-harms and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and its protocol was registered at PROSPERO. We will systematically search PubMed, Web of Science, Cochrane Library and Scopus databases from inception to November 2020 without any language restrictions. We will include systematic reviews or meta-analyses: (1) comparing the efficacy and safety of any dose of PDE5i with each other, with placebo or with other effective treatments for the management of erectile function; (2) exploring the use of any PDE5i alone or in combination with other treatment modalities in the general male population or in specific subgroups and (3) conducted with systematic procedures. Our overview will employ the AMSTAR 2 tool to evaluate the quality of the included studies and the Grading of Recommendations Assessment, Development and Evaluation approach to assess the strength of evidence for all outcomes. We will construct forest plots of risk estimates with the corresponding CI for all outcomes.Ethics and disseminationIn this overview, we will undertake an extensive literature search in an attempt to evaluate the potential benefits and risks of treatment with one PDE5i versus another or versus placebo and provide recommendations for clinicians and policy-makers. No ethical approval is required.PROSPERO registration numberCRD42020216754.

The Effect of Phosphodiesterase-type 5 Inhibitors on Erectile Function: An Overview of Systematic Reviews

“…All findings in our study are reported in accordance with the PRIO-harms guidelines (Bougioukas et al, 2018;Bougioukas et al, 2019). We published our predefined protocol after registering the aims and methods of this overview of systematic reviews at PROSPERO (CRD42020216754) (Pyrgidis et al, 2021).…”

Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies

“…The PDe5 enzyme isoform is selectively localized in the cavernous smooth muscles. Together with the absence of important collateral effects, this has made orally active PDe5 inhibitors the most efficacious drugs commercially available for ED therapy [31,43,44]. Among these are globally available sildenafil, vardenafil, tadalifil and avenafil [45], while mirodenafil [46], udenafil [47] and lodenafil [48] are available (the first two only in Korea, and the latter only in Brazil).…”

Pyroptosis and inflammation‑mediated endothelial dysfunction may act as key factors in the development of erectile dysfunction (Review)

“…PDE5 inhibitors are the most commonly used treatment options, which exert anti-inflammatory effects; however, 30% of patients are not sensitive to them ( 10 ). Furthermore, a previous review reported that PDE5 inhibitors induce headache, inflammation, digestive issues and other adverse effects, which limits their widespread usage in clinical practice ( 11 ).…”