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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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3
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Corona G, Cucinotta D, Di Lorenzo G, Ferlin A, Giagulli VA, Gnessi L, Isidori AM, Maiorino MI, Miserendino P, Murrone A, Pivonello R, Rochira V, Sangiorgi GM, Stagno G, Foresta C, Lenzi A, Maggi M, Jannini EA. The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction. J Endocrinol Invest 2023; 46:1241-1274. [PMID: 36698034 PMCID: PMC9876440 DOI: 10.1007/s40618-023-02015-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. CONCLUSIONS These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - D Cucinotta
- Chair of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Di Lorenzo
- Section of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", Bari, Italy
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - L Gnessi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Section of Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M I Maiorino
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Miserendino
- Diabetology and Endocrinology Unit, ASP #, Caltanissetta, Italy
| | - A Murrone
- Cardiology Unit, Città di Castello and Gubbio-GualdoTadino Hospitals, Azienda Usl Umbria 1, Gubbio, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G M Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - G Stagno
- Diabetology Unit, ASP Reggio Calabria, Reggio Calabria, Italy
| | - C Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - A Lenzi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, E Tower South Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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Longoni M, Bertini A, Schifano N, Zaffuto E, Maggio P, Piercarlo R, Baldini S, Carcano G, Antonini G, Salonia A, Montorsi F, Dehò F, Capogrosso P. A review on pharmacological options for the treatment of erectile dysfunction: state of the art and new strategies. Expert Opin Pharmacother 2023; 24:1375-1386. [PMID: 37272398 DOI: 10.1080/14656566.2023.2221785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) affects between 12.9% and 28.1% of men worldwide, presenting a strong aged-correlated prevalence. Several pharmacological treatments are currently available for ED, which can be classified into oral, injection, and topical/intraurethral therapies. AREAS COVERED Extensive research on PubMed/MEDLINE until February 2023 was performed. For each of the aforementioned drug classes, available molecules, and formulations, their efficacy and most common adverse events as well as general guidelines on prescription were investigated and extensively described. A glimpse into future directions regarding ED pharmacotherapy is also present. EXPERT OPINION In recent years, there have been significant developments in pharmacological treatments for ED. It is essential for physicians to identify the best treatment option for patients based on their preferences and sexual habits. The treatment approach for ED has shifted from a sequential to a parallel paradigm, where all treatment options are available as first-line therapies. While there are promising regenerative therapies for ED, such as shockwaves and platelet-rich plasma injections, pharmacological treatment is still the most effective option for most patients.
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Affiliation(s)
- Mattia Longoni
- Department of Urology, IRCCS San Raffaele Hospital; University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Bertini
- Department of Urology, IRCCS San Raffaele Hospital; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Emanuele Zaffuto
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Paolo Maggio
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Rossi Piercarlo
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Sara Baldini
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Giulio Carcano
- Department of Surgery, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Gabriele Antonini
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Andrea Salonia
- Department of Urology, IRCCS San Raffaele Hospital; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
| | - Paolo Capogrosso
- Department of Urology, ASST Sette Laghi - Circolo & Fondazione Macchi Hospital; University of Insubria, Varese, Italy
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Ševčíková A, Blinka L, Židlická A, Faltýnková A. Sexual Difficulties in People 50+: A Content Analysis of Sex-related Queries Posted on Professional Counseling Websites. HEALTH COMMUNICATION 2023; 38:958-966. [PMID: 34615416 DOI: 10.1080/10410236.2021.1984629] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although sexual activity has been found to be both important and challenging for people aged 50+, relatively little is known about the concerns that they have with respect to their sexual lives and how help-seeking behavior manifests on counseling platforms. A sample of 293 sex-related queries that Czechs aged 50+ posted on professional counseling websites were subjected to a quantitative and qualitative content analysis. The majority of posts were written by men and their dominant issues were erectile difficulties, partner's lack of interest in sex, and drug use/interaction when treating sexual difficulties and other ailments. Using a thematic analysis, the study showed that sex-related concerns were based within the context of worries about maintaining relationships and re-partnering in mid- and later life, and probing for the normal aspects of aging and the associated changes in sexual health. The online setting of the counseling websites facilitated the posting of both general and personalized queries to get oriented in problems, to triangulate with previous information, and to check the treatability of difficulties when past treatments failed. These findings suggest that online counseling puts a great demand on professionals' knowledge and understanding of the specifics of later-life sexual health.
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Affiliation(s)
- Anna Ševčíková
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University
| | - Lukas Blinka
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University
| | - Anna Židlická
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University
| | - Anna Faltýnková
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University
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Nik-Ahd F, Shindel AW. Pharmacotherapy for Erectile Dysfunction in 2021 and Beyond. Urol Clin North Am 2022; 49:209-217. [DOI: 10.1016/j.ucl.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Kontsioti E, Maskell S, Bensalem A, Dutta B, Pirmohamed M. Similarity and Consistency Assessment of Three Major Online Drug-Drug Interaction Resources. Br J Clin Pharmacol 2022; 88:4067-4079. [PMID: 35362214 PMCID: PMC9545693 DOI: 10.1111/bcp.15341] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022] Open
Abstract
AIM To explore the level of agreement on drug-drug interaction (DDI) information listed in three major online drug information resources (DIRs) in terms of: (1) interacting drug pairs; (2) severity rating; (3) evidence rating and (4) clinical management recommendations. METHODS We extracted information from the British National Formulary (BNF), Thesaurus, and Micromedex. Following drug name normalisation, we estimated the overlap of the DIRs in terms of DDI. We annotated clinical management recommendations either manually, where possible, or through application of a machine learning algorithm. RESULTS The DIRs contained 51,481 (BNF), 38,037 (Thesaurus), and 65,446 (Micromedex) drug pairs involved in DDIs. The number of common DDIs across the three DIRs was 6,970 (13.54% of BNF, 18.32% of Thesaurus, and 10.65% of Micromedex). Micromedex and Thesaurus overall showed higher levels of similarity in their severity ratings, while the BNF agreed more with Micromedex on the critical severity ratings and with Thesaurus on the least significant ones. Evidence rating agreement between BNF and Micromedex was generally poor. Variation in clinical management recommendations was also identified, with some categories (i.e. Monitor and Adjust dose) showing higher levels of agreement compared to others (i.e. Use with caution, Wash-out, Modify administration). CONCLUSIONS There is considerable variation in the DDIs included in the examined DIRs, together with variability in categorisation of severity and clinical advice given. DDIs labelled as critical were more likely to appear in multiple DIRs. Such variability in information could have deleterious consequences for patient safety, and there is a need for harmonisation and standardisation.
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Affiliation(s)
- Elpida Kontsioti
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, United Kingdom.,Institute for Risk and Uncertainty, University of Liverpool, Liverpool, United Kingdom
| | - Simon Maskell
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, United Kingdom
| | | | - Bhaskar Dutta
- Patient Safety Center of Excellence, AstraZeneca, Gaithersburg, MD, United States
| | - Munir Pirmohamed
- The Wolfson Centre for Personalized Medicine, MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Abdel-Raoof AM, Hasan MA, Madkour AW, Abdel-Fattah A, Eissa MS. Simultaneous determination of citalopram and tadalafil by the second derivative synchronous fluorescence method in biological fluids; application of Box-Behnken optimization design. LUMINESCENCE 2020; 36:57-65. [PMID: 32678940 DOI: 10.1002/bio.3913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 07/11/2020] [Indexed: 01/08/2023]
Abstract
This is the first study focusing solely on that determination of tadalafil in the presence of citalopram as an antidepressant drug. The determination in biological fluids of a co-administered antidepressant drug and a sexual stimulation drug is a very critical and important step for psychotic and ischaemic heart disease patients, especially in cases of emergency and this requires therapeutic drug monitoring. A sensitive, efficient and rapid assay was selected satisfactorily and applied for simultaneous determination of citalopram and tadalafil either in their pure forms, in tablet dosage forms or in spiked human plasma. There was a large overlap for both drugs, forming the broad band found in conventional fluorescence spectra and their related synchronous fluorescence intensity. Therefore, the development of a highly sensitive second derivative synchronous fluorescence method was demonstrated that removed this overlap. The proposed method depended on measuring the amplitudes of the second derivative of synchronous fluorescence intensity at suitable wavelengths of 301 nm and 367 nm for citalopram and tadalafil at Δλ = 60 nm, respectively. Box-Behnken design as a response surface methodology was used to fit models and create an optimization process encompassing a set of factors and resulting in an optimum response value specifically designed for this method. Under optimum conditions, the linear dynamic ranges for citalopram and tadalafil estimation were 20-900 and 5-400 ng ml-1 with detection limits of 5.40 and 1.43 ng ml-1 , respectively.
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Affiliation(s)
- Ahmed M Abdel-Raoof
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Mohamed A Hasan
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Ahmed W Madkour
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Ashraf Abdel-Fattah
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Maya S Eissa
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo, Egypt
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9
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Yang DY. Pharmacological management of male sexual dysfunction. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.6.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Male sexual disorders, which are the target of clinical treatment, can be largely divided into erectile dysfunction (ED), ejaculation disorder, infertility, sexual desire disorder, hypogonadism, and other diseases related to penile structure changes, such as Peyronieʼs disease. Current approaches to ED treatment for most men are based on pharmacotherapy. Pharmacotherapy has evolved since the introduction of papaverine and phenoxybenzamine in the early 1980s. Sildenafil, a phosphodiesterase type 5 inhibitor (PDE5I), was the first approved drug for ED. Currently, PDE5Is are the most widely prescribed drugs and have an overall efficacy of 60% to 80% in all categories of ED. Most drugs used in ED are peripheral agents that act on the penis. If a combined treatment with a central nervous system agent and peripheral agents is possible, it may be an effective treatment strategy with higher efficacy. Premature ejaculation (PE) is the most frequent ejaculatory disorder. The absence of a consensus on the definition of PE has served as an obstacle in the investigation of its prevalence and the effectiveness of treatment strategies. Although the etiology of PE is unknown, some biological and psychological hypotheses, including anxiety, penile hypersensitivity, and 5-hydroxytryptamine receptor dysfunction have been suggested. Dapoxetine hydrochloride, a short-acting selective serotonin reuptake inhibitor, was approved for on-demand treatment of PE. Off-label use of antidepressants, topical anesthetic agents, tramadol, and PDE5Is is now available as a pharmacological option. The aim of this review is to describe recent advancements in the pharmacological treatment of male sexual disorders, especially focused on ED and PE.
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Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells 2020; 9:E1250. [PMID: 32438565 PMCID: PMC7290763 DOI: 10.3390/cells9051250] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) is an inability to attain or maintain adequate penile erection for successful vaginal intercourse, leading to sexual and relationship dissatisfaction. To combat ED, various surgical and non-surgical approaches have been developed in the past to restore erectile functions. These therapeutic interventions exhibit significant impact in providing relief to patients; however, due to their associated adverse effects and lack of long-term efficacy, newer modalities such as regenerative therapeutics have gained attention due to their safe and prolonged efficacy. Stem cells and platelet-derived biomaterials contained in platelet-rich plasma (PRP) are thriving as some of the major therapeutic regenerative agents. In recent years, various preclinical and clinical studies have evaluated the individual, as well as combined of stem cells and PRP to restore erectile function. Being rich in growth factors, chemokines, and angiogenic factors, both stem cells and PRP play a crucial role in regenerating nerve cells, myelination of axons, homing and migration of progenitor cells, and anti-fibrosis and anti-apoptosis of damaged cavernous nerve in corporal tissues. Further, platelet-derived biomaterials have been proven to be a biological supplement for enhancing the proliferative and differentiation potential of stem cells towards neurogenic fate. Therefore, this article comprehensively analyzes the progresses of these regenerative therapies for ED.
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Affiliation(s)
- Ming-Che Liu
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan; (M.-C.L.); (C.-C.W.)
- Clinical Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, school of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Meng-Lin Chang
- Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 242, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Ya-Chun Wang
- TCM Biotech International Corp., New Taipei City 22175, Taiwan; (Y.-C.W.); (W.-H.C.)
| | - Wei-Hung Chen
- TCM Biotech International Corp., New Taipei City 22175, Taiwan; (Y.-C.W.); (W.-H.C.)
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan; (M.-C.L.); (C.-C.W.)
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shauh-Der Yeh
- Department of Urology and Oncology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Vaccher SJ, Hammoud MA, Bourne A, Lea T, Haire BG, Holt M, Saxton P, Mackie B, Badge J, Jin F, Maher L, Prestage G. Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102659. [PMID: 31927224 DOI: 10.1016/j.drugpo.2019.102659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. METHODS Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. RESULTS Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them. CONCLUSIONS Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
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Affiliation(s)
- Stefanie J Vaccher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Toby Lea
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Konrad-Adenauer-Ufer 79-81, 50668 Cologne, Germany; Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Bridget G Haire
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Brent Mackie
- ACON, 414 Elizabeth St, Surry Hills, NSW 2010, Australia.
| | - Joshua Badge
- School of Humanities and Social Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
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Isidori AM, Giammusso B, Corona G, Verze P. Diagnostic and Therapeutic Workup of Erectile Dysfunction: Results From a Delphi Consensus of Andrology Experts. Sex Med 2019; 7:292-302. [PMID: 31196744 PMCID: PMC6728771 DOI: 10.1016/j.esxm.2019.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Erectile dysfunction is a highly prevalent condition. Existing guidelines provide recommendations for diagnosis and treatment, but they are often disregarded in clinical practice in favor of a "patient-tailored" approach. OBJECTIVES We planned a Delphi consensus method to bridge the gap between evidence-based medicine and the real-life approach in daily practice. MATERIALS AND METHODS The Advisory Board prepared 15 statements on debated topics in andrology, each including 4-6 items designed as a 5-point Likert scale. After a validation phase, the questionnaire was sent by e-mail to a panel of experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the "hot topics" identified in the first round. RESULTS The first round of the Delphi consensus involved 101 experts; 71 (70%) also took part in the second round of voting. The Advisory Board deemed 22 items to be worthy of debate, and these underwent the second round of voting. "Real-life" results from the survey proved quite different from evidence-based recommendations. CONCLUSION Although guidelines suggest the best approach for a "standard" patient, real-life settings require flexibility. Diagnostic and therapeutic approaches should be tailored to the patients' needs. Phosphodiesterase type 5 inhibitors are recognized as the first-line therapy in both settings, including the newly introduced sildenafil orodispersible film. Indications from the panel might help close the gap between recommendations from guidelines and real-life practice in relation to the diagnosis and treatment of erectile dysfunction. Isidori AM, Giammusso B, Corona G, et al. Diagnostic and Therapeutic Workup of Erectile Dysfunction: Results From a Delphi Consensus of Andrology Experts. Sex Med 2019;7:292-302.
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Affiliation(s)
- Andrea M Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Rome, Italy.
| | - Bruno Giammusso
- Department of Urology, University of Catania, Catania, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Paolo Verze
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy
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Krzastek SC, Bopp J, Smith RP, Kovac JR. Recent advances in the understanding and management of erectile dysfunction. F1000Res 2019; 8. [PMID: 30740217 PMCID: PMC6348436 DOI: 10.12688/f1000research.16576.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 01/04/2023] Open
Abstract
Erectile dysfunction (ED) is important to a man’s well-being and health, since it not only affects the individual but also causes strain on a couple’s lifestyle and relationship. There are multiple non-invasive treatments that exist for ED including lifestyle changes, oral medications (phosphodiesterase type 5 inhibitors), vacuum-assisted erectile devices, and intraurethral suppositories. While lifestyle changes and oral medications are typically first-line treatments for ED, more-invasive treatments including intracavernosal injections and surgically implanted prosthetic devices may be required for the management of complex cases. Additionally, novel therapies are currently being developed, and future treatment options may include shock-wave therapy, external prosthetic devices, and injection of stem cells or platelet-rich plasma. The current manuscript seeks to highlight advances in management and may eventually alter the treatment paradigm to allow more-inclusive care pathways.
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Affiliation(s)
- Sarah C Krzastek
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Justin Bopp
- Men's Health Center, Indianapolis, Indiana, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
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Corona G, Maggi M, Jannini EA. EDEUS, a Real-Life Study on the Users of Phosphodiesterase Type 5 Inhibitors: Prevalence, Perceptions, and Health Care-Seeking Behavior Among European Men With a Focus on 2nd-Generation Avanafil. Sex Med 2018; 6:15-23. [PMID: 29275958 PMCID: PMC5815971 DOI: 10.1016/j.esxm.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/19/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) is a multidimensional disorder with an estimated prevalence of 1% to 10% in men younger than 40 years and up to 100% in men in their 70s and 80s. AIM To evaluate the real-life characteristics and unmet needs of men with ED, its impact on well-being, and treatment rates across Europe. METHODS Adult men in Belgium, France, Germany, Italy, Poland, Portugal, and Spain were invited to participate in the survey. Men who did not use at least a drug for sexual health in the past 3 months, had cancer or spinal cord injuries, and/or underwent non-nerve-sparing radical prostatectomy were excluded. MAIN OUTCOME MEASURES The 15-item International Index of Erectile Function (IIEF-15) with study-specific, self-constructed questions was used. RESULTS Overall, 940 subjects (age = 46.2 ± 13.4 years) were considered. Subjects (n = 778) using on-demand phosphodiesterase type 5 inhibitors (PDE5is) were designated "performers" (60%) without a formal ED diagnosis or "patients" with a medical diagnosis. Patients were older than performers, with more self-reported comorbidities; patients used a higher PDE5i dosage and purchased it from official pharmacies more often than performers did. Of avanafil users (n = 39), no differences in total IIEF or subdomain scores were observed after adjusting for confounders. However, avanafil users less often declared its use without an ED diagnosis and a physician prescription. Overall, the latter condition was associated with higher PDE5i-related satisfaction. CONCLUSION The survey shows 2 different attitudes toward ED and PDE5i use: for recreational use and without a medical prescription or with a formal diagnosis and medical prescription. Avanafil, a 2nd-generation PDE5i with a good balance between efficacy and tolerability profile, is more frequently prescribed by doctors than self-prescribed compared with other PDE5is. Because the major challenge is to decrease the high dropout of 1st-generation PDE5is, further studies will be needed to clarify this topic. Corona G, Maggi M, Jannini EA. EDEUS, a Real-Life Study on the Users of Phosphodiesterase Type 5 Inhibitors: Prevalence, Perceptions, and Health Care-Seeking Behavior Among European Men With a Focus on 2nd-Generation Avanafil. Sex Med 2018;6:15-23.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy; Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Abstract
Sexual dysfunction affects both men and women and is responsible for 1 in 5 visits to urologist and/or gynecologists. It is important that treating providers use a logical and methodical approach to the diagnosis and treatment of this disorder. Behavioral therapy, coupled with oral medications, are very successful in treating erectile dysfunction. Complex and invasive therapies are used for more severe cases of sexual dysfunction and are best deployed by specialists.
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Affiliation(s)
- Nelson Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Galter Pavilion Suite: 20-150, 675 North Saint Clair Street, Chicago, IL 60611, USA.
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Dougherty P. Erectile Dysfunction. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sexual Dysfunction in Type 2 Diabetes at Diagnosis: Progression over Time and Drug and Non-Drug Correlated Factors. PLoS One 2016; 11:e0157915. [PMID: 27706160 PMCID: PMC5051725 DOI: 10.1371/journal.pone.0157915] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/07/2016] [Indexed: 01/10/2023] Open
Abstract
Aims To present the longitudinal data of the SUBITO-DE study, a prospective survey involving male patients with new or recently diagnosed type 2 diabetes mellitus (T2DM) (<24 months). Materials and Methods Sexual function was assessed in male patients with T2DM at baseline (phase 1) and after a mean follow-up of 18 months (phase 2). Standard metabolic parameters and sexual and depressive symptoms were evaluated. Results Six of the 499 enrolled patients died of different causes during phase 1. Of the 493 surviving men invited to participate in phase 2, 450 (mean age 59.0±9.0 years) (90.2%) accepted and 43 (8.2%) were lost to follow-up. As compared to baseline, the proportion of the men who reported improvement in erectile dysfunction (ED) at follow-up was nearly double that of the men who reported worsening of ED (22.6% vs. 12.8%). The increase in frequency of sexual activity the men reported at follow-up assessment indicates that many never treated before baseline were taking an ED drug during the study period (106 subjects). Phosphodiesterase type 5 inhibitors (PDE5i) were the ED drugs most commonly taken at both baseline and follow-up. An overall improvement over baseline values was observed in metabolic targets for T2DM and depressive symptoms. Conversely, no change in lifestyle behaviors was recorded during the study. Conclusions Sexual dysfunction is a major concern in men with T2DM. The SUBITO-DE study demonstrates that, when combined with adequate counseling and tailored PDE5i therapy, an integrated approach to achieving metabolic targets in men with T2DM can improve sexual function as well as depressive symptoms.
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Corona G, Rastrelli G, Burri A, Serra E, Gianfrilli D, Mannucci E, Jannini EA, Maggi M. First-generation phosphodiesterase type 5 inhibitors dropout: a comprehensive review and meta-analysis. Andrology 2016; 4:1002-1009. [PMID: 27636710 DOI: 10.1111/andr.12255] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/13/2016] [Accepted: 06/20/2016] [Indexed: 11/29/2022]
Abstract
The discontinuation rate with phosphodiesterase type 5 inhibitors (PDE5i) remains very high. The aim of this study was to review and meta-analyze currently available data regarding dropout of the first-generation of PDE5i including sildenafil, vardenafil, and tadalafil. An extensive Medline Embase and Cochrane search was performed including the following words: 'PDE5i', 'discontinuation'. All observational studies reporting the dropout rate of PDE5i and its specific causes without any arbitrary restrictions were included. Out of 103 retrieved articles, 22 were included in the study. Retrieved trials included a total of 162,936 patients with a mean age of 58.8 ± 7.9 years. Prevalence of reported comorbid diabetes and hypertension were 27.7% and 36.9%, respectively. PDE5i were associated with a mean discontinuation rate of 4% per month (almost 50% after one year). This rate was higher in younger subjects and in those reporting a higher prevalence of associated morbidities. Six main reasons of PDE5i dropout were identified in the evaluated trials. Partner-related problems and lack of efficacy represented the most important reasons for PDE5i discontinuation, although no significant difference among factors was detected. In conclusion, despite their high efficacy and easy administration, the discontinuation rate and dissatisfaction with PDE5i are still very high. Our data showed that no single factor plays a major role in PDE5i dropout, suggesting that the discontinuation rate is usually because of a combination of both medical problems and psychosocial and relational factors.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy
| | - G Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - A Burri
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - E Serra
- 'I Mulini' Medical Center, Cagliari, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Mannucci
- Diabetology, Careggi Teaching Hospital, Florence, Italy
| | - E A Jannini
- Endocrinology, Andrology and Medical Sexology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Abstract
Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.
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Corinaldesi C, Di Luigi L, Lenzi A, Crescioli C. Phosphodiesterase type 5 inhibitors: back and forward from cardiac indications. J Endocrinol Invest 2016; 39:143-51. [PMID: 26122487 PMCID: PMC4712255 DOI: 10.1007/s40618-015-0340-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/11/2015] [Indexed: 12/24/2022]
Abstract
PDE5 inhibitors (PDE5i) are widely known as treatment for erectile dysfunction (ED). This favorable action has emerged as a "side effect" from pioneering studies when PDE5i have been originally proposed as treatment for coronary artery disease (CAD). PDE5i showed marginal benefits for CAD treatment; although disappointing for that indication, they improved systemic and pulmonary vasodilation and ameliorated general endothelial function. Therefore, PDE5i have been approved and licensed also for pulmonary artery hypertension (PAH), besides ED. Nowadays, fine-tuned biomolecular mechanisms of PDE5i are well recognized to be beneficial onto myocardial contractility and geometry, to reduce tissue fibrosis, hypertrophy and apoptosis. PDE5i consistently exert benefits on heart failure, infarct, cardiomyopathy. The concept that PDE5i likely blunt Th1-driven inflammatory processes, which shift the homeostatic balance from health to disease, has emerged; PDE5i seem to decrease the release of active biomolecules from cells to tissues interested by inflammation. In this view, following clinical and basic research progresses, PDE5i can be undoubtedly "re-allocated" for cardiac indications and, hopefully, they could be approved as therapeutic tools to treat and prevent heart disease. This review aims to summarize PDE5i different clinical applications, from past to present and future, focusing on their potential power as treatment for cardiac diseases.
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MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Cardiovascular Agents/pharmacokinetics
- Cardiovascular Agents/pharmacology
- Cardiovascular Agents/therapeutic use
- Cardiovascular Diseases/drug therapy
- Cardiovascular Diseases/immunology
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/physiopathology
- Coronary Artery Disease/drug therapy
- Coronary Artery Disease/immunology
- Coronary Artery Disease/metabolism
- Coronary Artery Disease/physiopathology
- Cyclic Nucleotide Phosphodiesterases, Type 5/chemistry
- Cyclic Nucleotide Phosphodiesterases, Type 5/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/immunology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Evidence-Based Medicine
- Heart/drug effects
- Heart/physiopathology
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Myocardium/enzymology
- Myocardium/immunology
- Myocardium/metabolism
- Phosphodiesterase 5 Inhibitors/pharmacokinetics
- Phosphodiesterase 5 Inhibitors/pharmacology
- Phosphodiesterase 5 Inhibitors/therapeutic use
- Vasodilator Agents/pharmacokinetics
- Vasodilator Agents/pharmacology
- Vasodilator Agents/therapeutic use
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Affiliation(s)
- C Corinaldesi
- Department of Movement, Human and Health Sciences, Section of Health Science, Unit of Endocrinology, University of Rome "Foro Italico", Rome, Italy
| | - L Di Luigi
- Department of Movement, Human and Health Sciences, Section of Health Science, Unit of Endocrinology, University of Rome "Foro Italico", Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Crescioli
- Department of Movement, Human and Health Sciences, Section of Health Science, Unit of Endocrinology, University of Rome "Foro Italico", Rome, Italy.
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21
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Corona G, Rastrelli G, Burri A, Jannini EA, Maggi M. The safety and efficacy of Avanafil, a new 2nd generation PDE5i: comprehensive review and meta-analysis. Expert Opin Drug Saf 2016; 15:237-47. [DOI: 10.1517/14740338.2016.1130126] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Burri
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Emmanuele A. Jannini
- Endocrinology, Andrology and Medical Sexology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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22
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Pastuszak AW, Hyman DA, Yadav N, Godoy G, Lipshultz LI, Araujo AB, Khera M. Erectile dysfunction as a marker for cardiovascular disease diagnosis and intervention: a cost analysis. J Sex Med 2015; 12:975-84. [PMID: 25728904 DOI: 10.1111/jsm.12848] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a risk factor for cardiovascular disease (CVD). We examine the costs of screening men with ED for CVD risk factors and the cost savings of treating these at risk men. AIM This study aims to evaluate the effect of screening men presenting with ED for CVD risk factors and to determine the cost effectiveness of this screening protocol. METHODS The known incidence and prevalence of ED and CVD, the rate of undiagnosed CVD, and the effects of CVD treatment were used to model the change in prevalence of acute CVD events and ED as a function of the number of men with ED and CVD. The cost savings associated with reduction in acute cardiovascular (CV) events and ED prevalence was estimated over 20 years. MAIN OUTCOME MEASURES Acute CVD event rate reduction and associated cost savings were modeled over 20 years. RESULTS The relative risk of ED in men with CVD is 1.47 and the coprevalence of both ED and CVD was estimated at 1,991,520 men. Approximately 44% of men with CVD risk factors are unaware of their risk. If all men presenting with ED were screened for CVD, 5.8 million men with previously unknown CVD risk factors would be identified over 20 years, costing $2.7 billion to screen. Assuming a 20% decrease in CV events as a result of screening and treatment, 1.1 million cardiovascular events would be avoided, saving $21.3 billion over 20 years. Similarly, 1.1 million cases of ED would be treated, saving $9.7 billion. Together, the reduction in acute CVD and ED treatment cost would save $28.5 billion over 20 years. CONCLUSIONS Screening for CVD in men presenting with ED can be a cost-effective intervention for secondary prevention of both CVD and, over the longer term, ED.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Corona G, Maseroli E, Rastrelli G, Isidori AM, Sforza A, Mannucci E, Maggi M. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf 2014; 13:1327-51. [PMID: 25139126 DOI: 10.1517/14740338.2014.950653] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Recent reports have significantly halted the enthusiasm regarding androgen-boosting; suggesting that testosterone supplementation (TS) increases cardiovascular (CV) events. AREAS COVERED In order to overcome some of the limitations of the current evidence, the authors performed an updated systematic review and meta-analysis of all placebo-controlled randomized clinical trials (RCTs) on the effect of TS on CV-related problems. Out of 2747 retrieved articles, 75 were analyzed, including 3016 and 2448 patients in TS and placebo groups, respectively, and a mean duration of 34 weeks. Our analyses, performed on the largest number of studies collected so far, indicate that TS is not related to any increase in CV risk, even when composite or single adverse events were considered. In RCTs performed in subjects with metabolic derangements a protective effect of TS on CV risk was observed. EXPERT OPINION The present systematic review and meta-analysis does not support a causal role between TS and adverse CV events. Our results are in agreement with a large body of literature from the last 20 years supporting TS of hypogonadal men as a valuable strategy in improving a patient's metabolic profile, reducing body fat and increasing lean muscle mass, which would ultimately reduce the risk of heart disease.
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Affiliation(s)
- Giovanni Corona
- Azienda-Usl Bologna, Maggiore-Bellaria Hospital, Medical Department, Endocrinology Unit , Bologna , Italy
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24
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Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, Rochira V, Sforza A, Lenzi A, Mannucci E, Maggi M. Testosterone Supplementation and Sexual Function: A Meta-Analysis Study. J Sex Med 2014; 11:1577-92. [DOI: 10.1111/jsm.12536] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol 2014; 2014:878670. [PMID: 24744785 PMCID: PMC3976909 DOI: 10.1155/2014/878670] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.
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Affiliation(s)
- Pietro Gareri
- Elderly Health Care, ASP Catanzaro, Via Spasari, 3, 88100 Catanzaro, Italy
| | | | - Davide Francomano
- Department of Medical Pathophysiology, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Gregorio Cerminara
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Pasquale De Fazio
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
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Ashour AE, Rahman AFMM, Kassem MG. Vardenafil dihydrochloride. PROFILES OF DRUG SUBSTANCES, EXCIPIENTS, AND RELATED METHODOLOGY 2014; 39:515-44. [PMID: 24794912 DOI: 10.1016/b978-0-12-800173-8.00009-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Vardenafil (VAR) is synthetic, highly selective, and potent inhibitor of phosphodiesterase-5 which competitively inhibits cyclic guanosine monophosphate (cGMP) hydrolysis and thus increases cGMP levels. It is clinically approved for treatment of erectile dysfunction in men, including diabetic and postprostatectomy patients. Several methods of VAR synthesis are included in this review. UV spectroscopy of VAR showed a λmax of approximately 270nm, and IR spectroscopy principal peaks were observed at 3420 (NH), 1724 (CO), 1600 (CC, and CN), 1491 (CHCH) cm(-1). Characteristic carbonyl (CO) carbon was observed in nuclear magnetic resonance spectroscopy at 162.44ppm. The molecular mass was observed at m/z=488.9 (molecular weight=488.2) and the fragmentation pattern was studied using ion trap mass spectrometry. In addition, different analytical methods for determination of vardenafil are also described in this profile. Pharmacokinetic properties of VAR have great impact on efficacy. VAR is rapidly absorbed and slowly metabolized, with an absolute bioavailability of 15%. It is extensively metabolized by CYP3A4 into several metabolites, the most pharmacologically active of which is N-desethyl VAR (M1). The elimination half-life of VAR and M1 is about 4-5h. VAR is primarily excreted as metabolites in the feces and to a small extent in urine. VAR is generally well tolerated, with a favorable safety profile and few transient side effects, including headache, flushing, dyspepsia, and rhinitis.
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Affiliation(s)
- Abdelkader E Ashour
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - A F M Motiur Rahman
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed G Kassem
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Abstract
Sildenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE-5). A patent was registered for this drug in 1990, which expired in 2010. Since expiration, the drug has been marketed under various trade names or as generic drugs. Numerous clinical trials have been conducted addressing the effectiveness of the drug for erectile dysfunction (ED) and its safety regarding the presence or absence of specific comorbidities. After over 20 years in the market, we need to ask: has the scientific community reached a general consensus as to the overall efficacy and safety of the drug? Can we firmly state that the benefits of the drug outweigh its risks? This review suggests that sildenafil is an effective and easily manageable treatment for erectile dysfunction, both in the absence and in the presence of comorbidities. After two decades of the emergence of sildenafil as a drug of choice for the treatment of ED (and the numerous studies and clinical trials undertaken during this time span), it is now possible to state that the benefits of the drug do outweigh the risks, and represent an significant improvement in the quality of life in men with ED.
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Abstract
The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population.
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Affiliation(s)
- Lauren J Gleason
- Division of Geriatrics and Aging, Highland Hospital, Rochester, NY 14620, USA
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Rezvanfar MA, Rahimi HR, Abdollahi M. ADMET considerations for phosphodiesterase-5 inhibitors. Expert Opin Drug Metab Toxicol 2012; 8:1231-45. [PMID: 22769968 DOI: 10.1517/17425255.2012.698610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION ADMET (absorption, distribution, metabolism, excretion, and toxicity) profiling is an important aspect of all drug developments. The pharmaceutical industry must always consider ADMET properties in order to optimize drug candidates and to introduce new formulations against existing marketed drugs. Consequently, candidate drug development may be halted early in the discovery phase or during the more costly drug development process because of their poor ADMET properties. AREAS COVERED The main focus of this article is ADMET profiling, pharmacokinetic (PK) drug interactions, mechanisms and possible adverse drug reactions (ADRs) for approved phosphodiesterase-5 inhibitors (PDE5Is). The authors also look at the efficacy and non-erectogenic benefits of current PDE5Is, which are widely used by patients with erectile dysfunction (ED). The authors also discuss other unapproved PDE5Is such as aildenafil and udenafil, which are currently in use in clinical trials. EXPERT OPINION The authors believe that the enhancing effect of PDE5Is on the nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway means that PDE5Is could be used to treat various conditions. An important issue in their development is 'cross-talk' between PDE5 and other PDEs and thus their specificity for other PDEs. But while it might be difficult to achieve the ideal ADMET profile, it should not necessarily prevent further development of a lead PDE5I. The risk assessment of PDE5Is, with respect to their ADMET properties, is therefore very important for predicting drug-drug interactions, possible side effects, ADRs and its future clinical applications.
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Affiliation(s)
- Mohammad Amin Rezvanfar
- Tehran University of Medical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Department of Toxicology and Pharmacology, Tehran, Iran
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Lee RK, Chughtai B, Te AE, Kaplan SA. Sexual Function in Men with Metabolic Syndrome. Urol Clin North Am 2012; 39:53-62. [DOI: 10.1016/j.ucl.2011.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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31
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Salloum FN, Das A, Samidurai A, Hoke NN, Chau VQ, Ockaili RA, Stasch JP, Kukreja RC. Cinaciguat, a novel activator of soluble guanylate cyclase, protects against ischemia/reperfusion injury: role of hydrogen sulfide. Am J Physiol Heart Circ Physiol 2012; 302:H1347-54. [PMID: 22268103 DOI: 10.1152/ajpheart.00544.2011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cinaciguat (BAY 58-2667) is a novel nitric oxide (NO)-independent activator of soluble guanylate cyclase (sGC), which induces cGMP-generation and vasodilation in diseased vessels. We tested the hypothesis that cinaciguat might trigger protection against ischemia/reperfusion (I/R) in the heart and adult cardiomyocytes through cGMP/protein kinase G (PKG)-dependent generation of hydrogen sulfide (H(2)S). Adult New Zealand White rabbits were pretreated with 1 or 10 μg/kg cinaciguat (iv) or 10% DMSO (vehicle) 15 min before I/R or with 10 μg/kg cinaciguat (iv) at reperfusion. Additionally, adult male ICR mice were treated with either cinaciguat (10 μg/kg ip) or vehicle 30 min before I/R or at the onset of reperfusion (10 μg/kg iv). The PKG inhibitor KT5283 (KT; 1 mg/kg ip) or dl-propargylglycine (PAG; 50 mg/kg ip) the inhibitor of the H(2)S-producing enzyme cystathionine-γ-lyase (CSE) were given 10 and 30 min before cinaciguat. Cardiac function and infarct size were assessed by echocardiography and tetrazolium staining, respectively. Primary adult mouse cardiomyocytes were isolated and treated with cinaciguat before simulated ischemia/reoxygenation. Cinaciguat caused 63 and 41% reduction of infarct size when given before I/R and at reperfusion in rabbits, respectively. In mice, cinaciguat pretreatment caused a more robust 80% reduction in infarct size vs. 63% reduction when given at reperfusion and preserved cardiac function following I/R, which were blocked by KT and PAG. Cinaciguat also caused an increase in myocardial PKG activity and CSE expression. In cardiomyocytes, cinaciguat (50 nM) reduced necrosis and apoptosis and increased H(2)S levels, which was abrogated by KT. Cinaciguat is a novel molecule to induce H(2)S generation and a powerful protection against I/R injury in heart.
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Affiliation(s)
- Fadi N Salloum
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, USA
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Focus on Phosphodiesterase Inhibitors for the Treatment of Erectile Dysfunction in Older Men. Clin Ther 2011; 33:1590-608. [DOI: 10.1016/j.clinthera.2011.09.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 09/24/2011] [Accepted: 09/26/2011] [Indexed: 11/19/2022]
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Corona G, Mondaini N, Ungar A, Razzoli E, Rossi A, Fusco F. Phosphodiesterase type 5 (PDE5) inhibitors in erectile dysfunction: the proper drug for the proper patient. J Sex Med 2011; 8:3418-32. [PMID: 21995676 DOI: 10.1111/j.1743-6109.2011.02473.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a very common multidimensional disorder affecting men worldwide. Physical illness, reaction to life stresses, or an unhappy couple relationship influence clinical outcome. Phosphodiesterase type 5 (PDE5) inhibitors are recognized as efficacious and well tolerated, and are the first-line treatment for ED. Sildenafil, tadalafil, and vardenafil are the most widely used and studied PDE5 inhibitors. Data acquired during a routine diagnostic workup for ED should be taken into account when choosing the best PDE5 inhibitor for the individual patient, creating an individualized treatment plan, and going beyond "experience-based" subjective opinion and unfounded ideas and prejudice regarding currently available drugs. AIM As the process of matching a given patient's profile to any selected PDE5 inhibitor often relies more on physician's personal convictions than on solid evidence, the aim of this review is to identify the main clinical, demographic, and relational factors influencing the choice of the PDE5 inhibitor to be used for the treatment of ED. METHODS A systematic literature search and current treatment guidelines were evaluated in a systematic manner. MAIN OUTCOME MEASURES The main clinical, cultural, and demographical factors to be considered for the treatment of ED have been identified. RESULTS Main factors influencing the choice of the treatment for ED have been described. A short list of items that may help in choosing the right PDE5 inhibitor for the treatment of different patients in daily clinical practice has been prepared. CONCLUSIONS The simple algorithms prepared should be a useful tool to be used in daily practice, which may help in choosing the right treatment for each subject affected by ED.
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Affiliation(s)
- Giovanni Corona
- Andrology and Sexual Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Azzouni F, Abu samra K. Are Phosphodiesterase Type 5 Inhibitors Associated with Vision‐Threatening Adverse Events? A Critical Analysis and Review of the Literature. J Sex Med 2011; 8:2894-903. [DOI: 10.1111/j.1743-6109.2011.02382.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Karavitakis M, Komninos C, Theodorakis PN, Politis V, Lefakis G, Mitsios K, Koritsiadis S, Doumanis G. Evaluation of Sexual Function in Hypertensive Men Receiving Treatment: A Review of Current Guidelines Recommendation. J Sex Med 2011; 8:2405-14. [DOI: 10.1111/j.1743-6109.2011.02342.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The numerous and varying effects of androgen deficiency in males cause an array of symptoms and complaints any of which can be the trigger for a medical consultation. It is, therefore, important to consider the possibility of late onset hypogonadism (LOH) in a patient who is presenting with any such symptoms. This review describes LOH and the current guidelines for its treatment and management. Also discussed are the normal changes undergone by men as they age and the effects that are expected due to this change. The relationship between LOH and its effects on both sexuality and fertility are also considered.
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Affiliation(s)
- Kevan Wylie
- University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.
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Sperling H, Gittelman M, Norenberg C, Ulbrich E, Ewald S. Efficacy and Safety of an Orodispersible Vardenafil Formulation for the Treatment of Erectile Dysfunction in Elderly Men and Those with Underlying Conditions: An Integrated Analysis of Two Pivotal Trials. J Sex Med 2011; 8:261-71. [DOI: 10.1111/j.1743-6109.2010.02005.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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38
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Hwang SY, Sohn SH, Wee JJ, Yang JB, Kyung JS, Kwak YS, Kim SW, Kim SK. Panax ginseng Improves Senile Testicular Function in Rats. J Ginseng Res 2010. [DOI: 10.5142/jgr.2010.34.4.327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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39
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Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW, ADT Survivorship Working Group. Androgen Deprivation Therapy for Prostate Cancer: Recommendations to Improve Patient and Partner Quality of Life. J Sex Med 2010; 7:2996-3010. [DOI: 10.1111/j.1743-6109.2010.01902.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Eardley I, Lee JC, Shabsigh R, Dean J, Maggi M, Neuser D, Norenberg C. Vardenafil improves erectile function in men with erectile dysfunction and associated underlying conditions, irrespective of the use of concomitant medications. J Sex Med 2010; 7:244-55. [PMID: 20104672 DOI: 10.1111/j.1743-6109.2009.01547.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Men with erectile dysfunction (ED) are also likely to have associated underlying conditions. AIM This retrospective analysis evaluated the efficacy and safety of vardenafil in men with ED and underlying conditions, including those taking concomitant medications. METHODS A total of 13 randomized, double-blind, placebo-controlled clinical studies were included. Vardenafil was administered at a starting dose of 10 mg, adjustable to 5 or 20 mg after 4 weeks. Efficacy analyses were performed on the intent-to-treat (ITT) population, using a last observation carried forward approach. Efficacy was assessed for subgroups of patients with diabetes, hypertension, dyslipidemia, or metabolic syndrome (as defined by International Diabetes Federation criteria). Incidence rates of treatment-emergent adverse events were analyzed overall and by subgroup for patients in the safety population. MAIN OUTCOME MEASURES Primary efficacy measures were the erectile function domain of the International Index of Erectile Function (IIEF-EF), and Sexual Encounter Profile questions 2 and 3 (SEP2, SEP3). RESULTS In total, 4,326 patients were randomized to treatment; the ITT population included 4,143 patients, with 4,266 patients valid for safety. At 12 weeks, vardenafil therapy was associated with statistically significant improvements from baseline in IIEF-EF scores, and SEP2 and SEP3 success rates, including patients with ED and diabetes, hypertension, dyslipidemia, or metabolic syndrome. These improvements were irrespective of level of glycemic control, or use of concomitant medications for the treatment of diabetes, hypertension, or dyslipidemia. Across all subgroups, the number and type of treatment-emergent adverse events were consistent with results from previous studies of phosphodiesterase type 5 inhibitors in men with ED and underlying conditions. CONCLUSIONS Vardenafil demonstrated favorable efficacy and tolerability in this large pool of patients with ED and underlying conditions. Importantly, the use of concomitant medications was not associated with any noteworthy changes in the efficacy or safety profile of vardenafil.
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Affiliation(s)
- Ian Eardley
- Pyrah Department of Urology, St. James's University Hospital, Leeds, UK.
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Corona G, Boddi V, Balercia G, Rastrelli G, De Vita G, Sforza A, Forti G, Mannucci E, Maggi M. The Effect of Statin Therapy on Testosterone Levels in Subjects Consulting for Erectile Dysfunction. J Sex Med 2010; 7:1547-56. [DOI: 10.1111/j.1743-6109.2009.01698.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Corona G, Boddi V, Lotti F, Gacci M, Carini M, De Vita G, Sforza A, Forti G, Mannucci E, Maggi M. The Relationship of Testosterone to Prostate-Specific Antigen in Men with Sexual Dysfunction. J Sex Med 2010; 7:284-92. [DOI: 10.1111/j.1743-6109.2009.01549.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Morales AM, Mirone V, Dean J, Costa P. Vardenafil for the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging 2009; 4:463-72. [PMID: 20054411 PMCID: PMC2801586 DOI: 10.2147/cia.s3878] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Indexed: 01/23/2023] Open
Abstract
Many men with erectile dysfunction (ED) also have associated underlying cardiovascular and metabolic conditions, for which they are likely to be taking medication. Therefore, cardiovascular safety and potential drug interactions are two of the major concerns when using PDE-5 inhibitors in these patients. The PDE-5 inhibitor, vardenafil, is characterized by a rapid onset of action, increased duration of erection, high rates of first-dose success and reliable efficacy that can be maintained with continued use. In both clinical trials and real-life observational studies, vardenafil has demonstrated a favorable efficacy and safety profile in men with ED, including those with associated underlying conditions such as diabetes, hypertension and dyslipidemia. Importantly, the concomitant use of medication for these conditions is not associated with any noteworthy changes in the efficacy and safety of vardenafil. The evidence presented in this review supports the use of vardenafil as a first-line treatment for men with ED, including those with underlying conditions.
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Borges R, Temido P, Sousa L, Azinhais P, Conceição P, Pereira B, Leão R, Retroz E, Brandão Á, Cristo L, Sobral F. Metabolic Syndrome and Sexual (Dys)function. J Sex Med 2009; 6:2958-75. [DOI: 10.1111/j.1743-6109.2009.01412.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Corona G, Mannucci E, Forti G, Maggi M. Following the common association between testosterone deficiency and diabetes mellitus, can testosterone be regarded as a new therapy for diabetes? ACTA ACUST UNITED AC 2009; 32:431-41. [DOI: 10.1111/j.1365-2605.2009.00965.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Guo YL, Viswanathan VP, Chiang HS, Choi HK, Yip AWC, Shen W, Kopernicky V. Efficacy and safety of tadalafil taken as needed for the treatment of erectile dysfunction in Asian men: results of an integrated analysis. Asian J Androl 2009; 11:423-33. [PMID: 19377488 DOI: 10.1038/aja.2009.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We evaluated the efficacy and safety of as-needed tadalafil in a diverse clinical population (with varying patient demographics, disease severity, and comorbid medical conditions) of Asian men with erectile dysfunction (ED). An integrated analysis of five double-blind, placebo-controlled trials (N = 1 046) was performed. Patients were randomly assigned to receive 10 mg tadalafil (N = 185), 20 mg tadalafil (N = 510), or placebo (N = 351). Efficacy assessments included the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP) diary and Global Assessment Question (GAQ). Patients receiving 10 mg or 20 mg tadalafil showed significant improvement from baseline-to-end point on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) domain score in all clinical sub-populations analyzed, compared with patients receiving placebo (P < 0.001). The 10-mg and 20-mg tadalafil groups showed a mean success rate of 64.1% and 70.5% for sexual intercourse attempts (SEP3, successful intercourse), respectively, compared with 33.4% in the placebo group (P < 0.001), and 85.5% and 85.4% reported improved erections at end point GAQ, respectively, versus 43.5% in the placebo group (P < 0.001). Tadalafil was well tolerated across all groups studied. Headache and back pain were the most frequently reported adverse events. Overall, tadalafil was effective and well tolerated across a diverse clinical spectrum of Asian men with ED.
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Affiliation(s)
- Ying-Lu Guo
- Andrology Center, Peking University First Hospital, Peking University, Beijing 100009, China
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