Treatment satisfaction among men with concurrent benign prostatic hyperplasia and erectile dysfunction treated with tadalafil or other phosphodiesterase type-5 inhibitor combinations

Abstract

ObjectiveErectile dysfunction (ED) and benign prostatic hyperplasia (BPH) frequently co-occur in men aged ≥40, along with lower urinary tract symptoms (LUTS) secondary to BPH. Given little real-world evidence on treatment use or satisfaction with treatment for concurrent BPH/LUTS and/or ED, this study examined medication regimens and differences in satisfaction and health-related quality of life (HRQoL) across regimens among men with concurrent BPH and ED.MethodsA cross-sectional study was conducted using an Internet survey of participants recruited through an online panel. Respondents (N=736) included men (aged ≥40) who self-reported a diagnosis of both ED and BPH with prescription treatment in the past 3 months for both conditions. Treatment satisfaction (eg, convenience and ease of planning) and HRQoL (eg, International Prostate Symptom Score, sleep quality) were self-reported. Generalized linear models examined the association of regimen with treatment satisfaction and HRQoL, adjusting for covariates (eg, age and comorbidities).ResultsFinal analyses included participants (N=507) using: tadalafil once-daily monotherapy (22%), tadalafil for ED with an alternate BPH therapy (36%), or another phosphodiesterase type-5 inhibitor (PDE5-I) combination (41%). These groups represented the major categories of treatment regimens found in the sample, excluded participants with ambiguous regimens, and were aligned with current standard of care for BPH and ED. Overall, patients reported moderate levels of BPH and a moderate-to-severe degree of ED. Tadalafil monotherapy patients had higher treatment satisfaction scores and greater reported ease of treatment planning and convenience than PDE5-I combination patients. No significant intergroup differences were found on HRQoL.ConclusionA majority of patients (59%) took tadalafil alone or in combination for BPH/ED treatment. Tadalafil monotherapy patients reported greater treatment satisfaction than patients taking PDE5-I combination therapy. Higher satisfaction for both effectiveness and convenience of once-daily tadalafil may inform both patient and clinician decisions regarding pharmacotherapy regimens.

Value of phosphodiesterase 5 inhibitors as a combination therapy for treating erectile dysfunction: A literature review

“…Lastly, a cross‐sectional survey was included. Tadalafil monotherapy scored significantly higher on patient satisfaction and convenience than tadalafil combined with α‐blockers and/or 5α‐reductase inhibitors (5‐ARIs) [ 15 ] (Table 3).…”

“…Regarding patient satisfaction, Lee et al [15] conducted an internet survey of 507 men with both ED and BPH.…”

Discontinuation Rates of Tadalafil Alone and in Combination with a-Blockers in the Treatment of Male Lower Urinary Tract Symptoms with or without Coexisting Erectile Dysfunction: A Systematic Review and Meta-Analysis

“…The least wanted undesirable effect was ejaculatory dysfunction (retrograde or diminished ejaculation), which is a well-known side effect of selective ABs [ 70 ]. This has previously been shown to be the main factor associated with high satisfaction in the tadalafil only group compared with the PDE5-I combination or tadalafil combination groups (both of which include the use of ABs) [ 71 ]. In our study, 9 patients in the CT group (tadalafil + tamsulosin) discontinued due to ejaculatory dysfunction.…”

Treatment persistence with a fixed-dose combination of tadalafil (5 mg) and tamsulosin (0.4 mg) and reasons for early discontinuation in patients with benign prostatic hyperplasia and erectile dysfunction

“…The most common undesirable effect was ejaculatory dysfunction, a well-known side effect of selective α-blockers [20]. This has previously been shown to be the main factor related to low satisfac-tion with combination treatment using α-blockers and PDE5 inhibitors [21]. However, other adverse events related to tadalafil may have less impact on treatment persistence, based on previous studies with once-daily tadalafil that reported discontinuation rates due to the side effect as low as 1% to 6% [22][23][24].…”