Giving Patients with Erectile Dysfunction the Opportunity to Try All Three Available Phosphodiesterase Type 5 Inhibitors Contributes to Better Long-Term Treatment Compliance

Abstract

Introduction There are three phosphodiesterase type 5 (PDE5) inhibitors marketed, sildenafil, Vardenafil, and tadalafil for oral treatment of erectile dysfunction (ED). Although the treatment is simple and mostly effective, around 50% has ceased to use the medication within 2 years. One recently described way to improve the compliance is to let the patient try all the three PDE5 inhibitors and to prescribe the drug(s) he and his partner desires. Aim To study long-term compliance among patients who were treated according to this “three-drug regime.” Main Outcome Measures Compliance and reasons for discontinuation after >2 years. Methods The men who, during 2003, were enrolled in a treatment regime, where they had the opportunity to test all the three drugs and to chose the one(s) they preferred, were interviewed in 2006 by telephone concerning their ongoing ED treatment and the reason for discontinuation. Results Of the 138 men, mean age 60 years (36–79 years), who had been enrolled and successfully treated with the three-drug regime, 127 (92%) could be reached. The mean follow-up time was 27 months (23–34 months). Of the 127 men, as many as 109 (86%) were still using PDE5 inhibitors. A few (8%) used more than two tablets per week. The majority (44%) used one to two tablets per week or one to two per month (43%), the others (5%) less often. The causes for discontinuation were varying. The most common reason (N=7) was return of a satisfactory non-assisted erection. Seventy-five percent of the men used only one drug; the others switched between a short- and long-acting drug depending on the situation. It was not uncommon (25%) that the preference had changed during the 3 years of PDE5 inhibitor use. Conclusion To let patients with ED test the three available PDE5 inhibitors results in an unusually high compliance even under an extended period of time (>2 years).

The safety and efficacy of Avanafil, a new 2ndgeneration PDE5i: comprehensive review and meta-analysis

“…Some studies documented that PDE5i switching improved erectile function for patients who did respond to the initial PDE5i. [27][28][29][30] However, no clinical conclusion can be drawn about the use of avanafil, due to limited data.…”

Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)

“…This strategy improves compliance and increases patient satisfaction. 247 Moreover, dose titration for a given PDE5 inhibitor to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment (grade of recommendation ¼ A). 248e250 Despite the favorable clinical data, high dropout rates exist.…”

Safety, Efficacy, and Patient and Partner Acceptability of Vardenafil Orally Disintegrating Tablets for the Treatment of Erectile Dysfunction

“…A 2007 study evaluating patient compliance found that 25% of patients changed their preferred PDE5i medication over a 3-year period. 19 Reviews evaluating patient preference for filmcoated PDE5i have consistently determined that the study results are inconclusive and limited by bias.…”