Efficacy and Safety of Tadalafil Once-a-Day versus Tadalafil On-Demand in Patients with Erectile Dysfunction: A Systematic Review and Meta-Analyses

Abstract

Introduction: To compare the efficacy and safety between tadalafil once-a-day and tadalafil on-demand dosing regimen in patients with ED. Materials and Methods: A systematic search of Medline, Embase, and Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared tadalafil used a once-a-day with an on-demand dosing regimen for erectile dysfunction. A secondary hand-search was performed in relevant journals, references, and the grey literature. Meta-analyses were performed using Review Manager version 5.3.0. Results: Six RCTs involving a total of 1,534 patients were included in this review. All studies reported the International Index of Erectile Function-Erectile Function domain score and the results of the meta-analysis showed no difference between the groups. The overall pooled estimated weighted mean differences (WMD) was 0.97 (95% CI -0.37 to 2.32; p = 0.16). Meta-analyses of Sexual Encounter Profile questions 2 and 3 (SEP-2 and SEP-3) showed that the once-a-day dosing regimen was superior to the on-demand regimen with statistical significance. The WMD of SEP-2 and SEP-3 were 10.32 (95% CI 3.16-17.48; p = 0.005) and 11.07 (95% CI 2.57-19.56; p = 0.01), respectively. Both dosing regimens of tadalafil showed similar complication rates. The meta-analyses of adverse events showed no significant differences. Conclusions: The efficacy rates of tadalafil once-a-day and on-demand were similar. No significant difference in safety was found between the 2 dose regimens of tadalafil.

Meta-Analysis of the Long-Term Efficacy and Tolerance of Tadalafil Daily Compared With Tadalafil On-Demand in Treating Men With Erectile Dysfunction

“…Some data suggested that partners might prefer the participants to take it daily rather than on-demand 21 9, 22…”

Novel Emerging Therapies for Erectile Dysfunction

“…Tadalafil was approved as a low dose (5 mg) daily regimen, as well as a classical on-demand regimen [21]. Both daily and on-demand dosing of tadalafil have been shown to exhibit the same efficacy [22]. However, daily regimen may increase the ability for spontaneity of sexual intercourse.…”

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

“…Bansal et al [40] reviewed 6 head to head studies of up to 12 weeks and concluded that daily tadalafil resulted in a 1.82 higher ED score then 20mg on-demand. Peng et al [41] included studies of up to 26 weeks and found superiority for tadalafil 5 mg daily especially in men with diabetes and post radical prostatectomy and especially when assessed by SEP, a diary completed daily as opposed to IIEF data which relies on memory of sexual attempts up to 6 months previously. Prasetyo [42] also concluded greater efficacy for once daily (OaD) vs. on-demand tadalafil based on SEP2 and SEP 3 data.…”