Efficacy of Continuous Dosing of Tadalafil Once Daily vs Tadalafil On Demand in Clinical Subgroups of Men With Erectile Dysfunction: A Descriptive Comparison Using the Integrated Tadalafil Databases

Spontaneous erectile function recovery among young men with erectile dysfunction taking tadalafil 5 mg once a day

BACKGROUND

Daily (once a day [OaD]) tadalafil intake is a valuable option for men favoring spontaneous over scheduled sexual intercourse.

AIM

The study sought to assess the rate of and the clinical factors associated with spontaneous, medication-free erectile function (EF) recovery after discontinuation of tadalafil 5 mg OaD in a cohort of young men seeking first medical help for psychogenic erectile dysfunction (ED) as their primary complaint.

METHODS

Data from 96 consecutive patients <50 years of age seeking first medical help for ED and prescribed tadalafil 5 mg OaD were analyzed. Patients completed the International Index of Erectile Function (IIEF) and underwent baseline penile color Doppler ultrasound. Follow-up involved clinical assessments or phone interviews. Spontaneous medication-free EF recovery was defined as IIEF EF domain score >22 after tadalafil discontinuation, prompting cessation of follow-up. Descriptive statistics compared tadalafil OaD responders and nonresponders. Cox regression hazard models explored the association between baseline characteristics and EF recovery risk post-drug discontinuation. Kaplan-Meier analyses estimated EF recovery probability over time.

OUTCOMES

The primary outcome was EF recovery after discontinuation of tadalafil 5 mg OaD.

RESULTS

Overall, median age was 39 (interquartile range [IQR], 32-45) years. Of all, 82 (85.4%) patients achieved EF recovery after tadalafil OaD discontinuation, while 14 (14.6%) patients were identified as nonresponders. Median tadalafil usage time (from beginning to discontinuation) was 3 (IQR, 2-11) months. The most common treatment-emergent adverse event was headache in 9 (9.4%) patients. Nonresponders were older (43 [IQR, 42-45] years vs 38 [IQR, 31-44] years; P = .03), had higher body mass index (25.5 [IQR, 23.4-29.9] kg/m2 vs 23.6 [IQR, 21.8-25.9] kg/m2; P = .04), and reported lower baseline IIEF EF domain scores (12 [IQR, 7-15] vs 15 [IQR, 10-22]; P = .02) than responders. Nonresponders and responders did not differ in terms of baseline ED severity, Charlson comorbidity index, smoking, alcohol consumption, regular physical exercise, and color Doppler ultrasound parameters. Upon Cox regression analysis, younger age (hazard ratio, 0.95; 95% confidence interval, 0.92-0.99; P = .01) was associated to EF recovery, after adjusting for baseline ED severity, body mass index, smoking, and Charlson comorbidity index ≥1. The Kaplan-Meier analysis displays the probability of EF recovery over time, indicating rates of 43%, 60%, and 72% at 3-, 6-, and 12-month follow-up intervals, respectively.

CLINICAL IMPLICATIONS

Tadalafil 5 mg OaD is an effective short-term treatment for psychogenic ED, allowing its discontinuation after achieving a normal medication-free EF.

STRENGTHS AND LIMITATIONS

The main limitations are the limited number of participants and the potential neglect of confounding factors.

CONCLUSION

Almost 1 out of 2 young men with primary psychogenic ED who were prescribed with tadalafil 5 mg OaD recovered spontaneous medication-free EF after 3 months of treatment. Overall, the younger the patient was, the higher the chance there was of spontaneous EF recovery after drug discontinuation.

Efficacy of low-intensity shockwave therapy with different tadalafil regimens in patients with PDE5 inhibitor-resistant erectile dysfunction: a retrospective cohort study

PURPOSE

Currently, there is a lack of research comparing tadalafil treatment protocols recommended during low-intensity shock wave therapy (LI-SWT) for patients with erectile dysfunction (ED) who are unresponsive to phosphodiesterase type 5 inhibitors (PDE5i). The objective of this study is to compare the efficacy of only LI-SWT versus LI-SWT plus 5 mg tadalafil daily versus LI-SWT plus 20 mg tadalafil alternate-day in PDE5i -resistant ED. MATERıALS AND METHODS: In this study, a cohort of 105 patients with PDE5i-resistant ED was recruited and divided into three groups labeled as A (only LI-SWT), B (LI-SWT plus 5 mg tadalafil daily), and C (LI-SWT plus 20 mg tadalafil alternate-day), comprising 27, 42, and 36 patients, respectively. The patients' International Index of Erectile Function-5 (IIEF-5) scores and the Erection Hardness Score (EHS) were evaluated at the baseline, three months and six months following the treatment.

RESULTS

After three months post-treatment, the IIEF-5 scores in group A, B, and C increased by 4.1 ± 0.6, 7.3 ± 0.6, and 8.2 ± 0.6, respectively. These improvements were maintained at six months with IIEF-5 scores increasing by 3.7 ± 0.6, 7.3 ± 0.6, and 8.5 ± 0.7 in groups A, B, and C, respectively. At 3 and 6 months post-treatment, groups B and C showed significant improvement in IIEF-5 scores and EHS values compared to group A (p < 0.001). The rate of patients with EHS ≥ 3 and IIEF-5 ≥ 17 was significantly higher in groups B and C compared to group A, while there was no significantly different between groups B and C. CONCLUSıON: In patients with PDE5i-resistant ED, PDE5i combined with LI-SWT is superior to LI-SWT monotherapy. The statistical analysis failed to demonstrate any difference between two distinct tadalafil regimens when administered with LI-SWT treatment.

The effect of vitamin D replacement in patients with lower urinary tract complaint/erectile dysfunction resistant to Tadalafil 5 mg treatment: A pilot clinical study

The aim of this study was to evaluate the effect of vitamin D replacement in patients with lower urinary tract symptoms (LUTS)/erectile dysfunction (ED) who did not respond to tadalafil 5 mg treatment. Patients who applied to the Andrology Clinic with LUTS/ED between September 2017 and August 2020 and used 5 mg Tadalafil daily for treatment and did not benefit from treatment for 1 month were included in the study. Vitamin D levels of the patients were analysed and Vitamin D3 100,000 IU/week oral therapy was administered for a month to the patients with low levels of Vitamin D(<20 ng/ml).The values of the patients before and after Vitamin D replacement were compared. A total of 84 patients were included in the study. The mean age was 49.175 ± 11.63(28-70) years and the mean BMI was 25.93 ± 6.82(18.26-37.87). Testosterone levels of the examined patients were 3.45 ± 0.99 ng/ml. After 1 month of Vitamin D replacement + Tadalafil 5 mg/d treatment, the international index of erectile function-erectile function (IIEF-EF) (pre-treatment: 10.73 ± 6.12, post-treatment: 24.18 ± 4.87; p = 0.001) and International Prostate Symptom Score (pre-treatment: 9.12 ± 7.16, post-treatment: 3.11 ± 1.08; p = 0.003) scores of the patients improved significantly. Evaluation of Vitamin D levels is important to improve treatment response, especially in patients who do not respond to PDE-5 inhibitors.

Role of shear wave elastography (SWE) in erectile dysfunction patients for evaluation of daily tadalafil treatment outcome

The purpose of this study was to evaluate and anticipate the outcome of daily use of tadalafil in patients with erectile dysfunction using elastography. 183 volunteers and 183 patients with erectile dysfunction were included. Pretreatment SWE readings for our patients were calculated with a linear probe. IIEF score Q was measured once at the start of the study for volunteers and twice for patients, one prior to the start of tadalafil administration and the other on one year of 5 mg daily tadalafil after the second post-washout (one month post-treatment stopped). There was no significant difference between patients and volunteers in mean age or risk factors except in SWE values as mean SWE of volunteers was 14.03 ± 1.54 kpasc, while mean SWE of patients was 21.278 ± 8.228 kpasc. The presence of comorbid diabetes, severe disease and pre-SWE ≥23.635 was significantly associated with poor outcome. We conclude that penile SWE could be useful to select probable good responders for a continuous tadalafil use, thus avoiding the unnecessary cost and time in non-responders.

Effect of tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with erectile dysfunction

Objective:

To evaluate the effect and clinical significance of tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with Erectile dysfunction (ED).

Methods:

Eighty patients with hyperlipidemia complicated with ED who were treated at The Second Hospital of Hebei Medical University from January 2019 to June 2020 were selected. Using a completely randomized design experimental method, these 80 patients were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. The control group was treated with a single drug, atorvastatin calcium, while the experimental group was given tadalafil orally on the basis of the control group for 3 months. Changes in the levels of inflammatory factors such as IL-6, TNF and CRP, adverse drug reactions, changes in hemodynamic indicators such as HSV, LSV, PSV, HCT and ESR before and after treatment, as well as changes in sexual function after treatment were compared and analyzed between the two groups.

Results:

TNF-a, CRP and IL-6 in the experimental group were significantly lower than those in the control group after treatment, with statistically significant differences (p<0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (p=0.18). After treatment, hemodynamic indexes and sexual function indexes of the experimental group were significantly improved compared with those in the control group, with statistically significant differences (p<0.05).

Conclusion:

A significant improvement effect can be achieved by tadalafil combined with atorvastatin on hemodynamics and sexual function in middle-aged and elderly patients with hyperlipidemia complicated with ED. At the same time, the combination of the two has synergism on inflammatory factors and blood rheology, and the incidence of adverse reactions is not significantly increased.

Canadian Urological Association guideline: Erectile dysfunction

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks.

Comparative Effectiveness of Tadalafil versus Tamsulosin in Treating Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia: A Meta-Analysis of Randomized Controlled Trials

Background

Evidence directly evaluating the efficacy of tadalafil vs. tamsulosin for lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) is limited. We performed a meta-analysis of published studies to assess the comparative effectiveness of tadalafil vs. tamsulosin in treating LUTS suggestive of BPH.

Material/Methods

After performing a comprehensive publication search with PubMed, EMBASE, and Cochrane Controlled Trials Register using the search terms “tadalafil”, “tamsulosin”, “lower urinary tract symptoms”, and “controlled”, 335 articles were screened, out of which 7 randomized controlled trials published up to July 2019 were identified and included in this meta-analysis review.

Results

From 335 screened articles, 7 studies (totalling 1601 patients) were finally included in our analysis. There was no statistically significant difference between tadalafil and tamsulosin in improving the clinical outcomes of total International Prostate Symptom Score (IPSS), voiding subscores, storage subscores, quality of life (QoL) scores, maximum flow rate (Qmax), and postvoid residual urine (PVR), but a statistically significant difference was observed in the International Index of Erectile Function scores (IIEF scores).

Conclusions

Tadalafil and tamsulosin have similar effects in managing LUTS secondary to BPH. Tadalafil is superior to tamsulosin in treating LUTS suggestive of BPH when associated with erectile dysfunction (ED).

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

Important health problems in men such as type 2 diabetes (T2DM), insulin resistance, erectile dysfunction, benign prostatic hyperplasia and depression have been shown to have to share common pathological processes, such as endothelial dysfunction and inflammation. This paper discusses the role of phosphodiesterase type 5 (PDE5) inhibitors, through beneficial effects on endothelial function and mediators of chronic inflammation and the possibility to treat or preventing these common conditions. We explore possible barriers to this approach, namely the lack of multiple product licences to treat each of these conditions and how these can be overcome by involving the patient in personalised decisions. We also discuss how opportunities are lost by patients with multiple medical conditions being referred to specialists, primarily interested in one specific problem, with little motivation to treat or prevent conditions outside their remit. We explore how these problems might be related to time and financial restraints or simply a lack of awareness of evidence published in journals related to other specialities. As specialists, we often pride ourselves on providing "personalised" or "patient centred" care, but we can only truly be doing so if we assess the specific needs of the patient across a range of conditions. As part of personalised care in T2DM, we routinely prescribe statins, angiotensin converting enzyme inhibitors and metformin, often with poor compliance. In this paper we explore whether the licensed daily PDE5 inhibitor tadalafil should be added routinely to this list as it will potentially improve and prevent bothersome symptoms and improve compliance with other medications.

Research of stroke combined hyperlipidemia-induced erectile dysfunction in rat model

Objective: The study was aimed to evaluate the influences of erectile dysfunction (ED) in a rat model of stroke combined with hyperlipidemia (HLP). Methods: Male Sprague-Dawley rats were divided into control and hyperlipidemia (HLP) groups. HLP model was constructed by feeding with high-fat and cholesterol diets. Serum levels of total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), and non-HDL were identified to check the model was success. Stroke model was established by FeCl₃. ICP/MAP value was detected to evaluate the erectile function of rats. Serum level of lipoproteins and the expressions of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) were detected by ELISA. Hematoxylin-eosin (HE) staining of corpus cavernosum and measurement of penis length were utilized to assessment erectile function. Western blot was used. Results: TC, TG, LDL, and non-HDL-C in serum were up-regulated, while HDL level was attenuated. After treatment, the serum lipid level recovered. From the ICP/MAP values, the erectile function of both two treatment groups recovered. The expression of PDE5A was up-regulated, while the levels of eNOS and cGMP were suppressed after surgery. The length of penis was decreased, and corpus cavernosum was damaged following HLP and stroke. However, the erectile function was recovered after treatment. Conclusion: Stroke combined HLP caused ED through NO-cGMP-PDE5 pathway.

Effects of Chaihu-Shugan-San capsule for psychogenic erectile dysfunction: Study protocol of a randomized placebo-controlled trial

BACKGROUND

Erectile dysfunction (ED) affects many adult men worldwide. Many studies on the brain of psychogenic ED have shown significant cerebral functional changes and reduced volume of gray matter and white matter microstructural alterations in widespread brain regions. Chaihu-Shugan-San (CHSGS) capsule has been used to treat ED from the 20th century in China. However, clinical research of CHSGS capsule in the treatment of ED was lack. We design this study to evaluate the efficacy and safety of CHSGS capsule in the treatment of patients suffering from psychogenic ED. Furthermore, we also aim to provide a new evidence as well as an innovation of the clinical treatment in psychogenic ED.

METHODS

This study is designed as a multi-center, 3-arms, randomized trial. From the perspective of psychogenic ED, we will divide patients into 3 groups, which are placebo group, tadalafil group and CHSGS group. One hundred thirty-five patients will be randomly allocated to receive placebo, CHSGS capsule or tadalafil oral pharmacotherapy. After the period of 4-week treatment, the outcome of primary assessment changes in the brain MRI, IIEF-5, EHS, and QEQ total scores from baseline. Secondary assessments include the SEAR, HAMA-14, HAMD-17 scores, response rate of the patients and their partners.

DISCUSSION

We designed this study based on previous research about psychogenic erectile dysfunction (ED). This study will provide objective evidences to evaluate the effects of CHSGS capsule as an adjuvant treatment for psychogenic ED.

TRIAL REGISTRATION NUMBER

chictr.org.cn, ChiCTR-IOR-1800018301.

Erectile Dysfunction: A Primer for in Office Management

Introduction: Optimizing erectile dysfunction (ED) remains a clinically significant endeavor as insufficient outcomes from oral, injectable and even surgical approaches to treatment remain less than ideal. In this report, we integrate evolving knowledge and provide an algorithmic approach for the clinician to fine-tune management. Methods: We performed a PubMed and Medline search of Erectile Dysfunction treatment optimization, enhanced patient efficacy for ED, and why men fail ED treatment. All relevant papers for the past two decades were reviewed. Results: Establishing the goals and objectives of the patient and partner while providing detailed instructions for treatment can minimize failures and create an environment that allows treatment optimization. A thorough work-up may identify reversible or contributing causes. We identified several areas where treatment of ED could be optimized. These include; management of associated medical conditions, lifestyle improvements, PDE5 inhibitor prescription strategies, management of hypogonadism and the initiation of intracavernosal injection therapy (ICI). Conclusions: In our view, once a man presents for help to the clinician, use of the simple strategies identified in this review to optimize the tolerability, safety and effectiveness of the selected treatment should result in enhanced patient and partner satisfaction, with improved outcomes.

Pharmacotherapy for erectile dysfunction in diabetic males

INTRODUCTION

Numerous studies have highlighted the intimate association between erectile dysfunction (ED) and diabetes mellitus (DM). However, the true pathogenesis of ED among diabetic men has not yet been fully discovered. The treatment of ED in diabetic patients remains an interesting area of research. The last two decades have witnessed phenomenal advances in the management of ED with the efficacy of pharmacotherapy for ED in diabetic patients encouraging, especially with introduction of innovative conservative tools for treatment.

AREAS COVERED

The aim of this review is to discuss the currently available information on ED pharmacotherapy in diabetic males and provide an expert perspective on the current treatment strategies.

EXPERT OPINION

Conservative treatment remains the initial step for the treatment of ED in diabetic patients. This kind of therapy consists of different modalities including: oral treatments, intracavernosal pharmacotherapy, and evolving modalities such as soluble guanylate cyclase activators, stem cells (SCs), and alternative treatments such as herbal treatment and transdermal/topical pharmacotherapy. However, it should be noted that the currently available pharmacotherapy is still far from ideal. One hopes to witness new drugs and technologies that may revolutionize ED treatment in the future, especially in such complex cases as DM.

MANAGEMENT OF ERECTILE DYSFUNCTION IN CARDIOVASCULAR PATIENTS WITH COMORBIDITIES: REVIEW OF THE TRIALS ON CONTINUING THERAPY WITH PHOSPHODIESTERASE-5 MEDICATIONS

The review is focused on the issues of erectile dysfunction (ED) management by long term courses of continuous intake of the phosphodiesteraze-5 type (PDE5) inhibitors. ED is an actual problem of modern healthcare, prevalent and influencing negatively life quality and interpersonal relations. At early stages the management of ED by the PDE5 inhibitor drugs was regarded as symptomatic. However recently there are more and more publications that confirm continuous long term intake of PDE5 inhibitors. This can be explained by the mechanism of this drugs class action that includes the causation of the disorder, particularly, endothelial dysfunction. It is well konwn that in erectile dysfunction there is malfunction of nitric oxide synthesis by endothelium, and long term usage of PDE5 facilitates the increase of biochemical reactions that can be started by nitric oxide. Based on the review data, a proposition made that PDE5 inhibitors are not harmful for cardiovascular system, but may present with positive effects on cardiovascular system in general. The trials towards this direction continue. There is also a suggestion that intake of PDE5 inhibitors helps to restore normal endothelial function that may lead to better condition of cardiovascular system and decrease complications rate.

Administration of daily 5 mg tadalafil improves endothelial function in patients with benign prostatic hyperplasia

INTRODUCTION

Tadalafil is a promising phosphodiesterase (PDE) 5 inhibitor prescribed for erectile dysfunction (ED). Daily low dose (5 mg) of tadalafil has also been used for the treatment of male lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH). PDE5 inhibitors induce relaxation of smooth muscle cells in the urethra, prostate, bladder neck, and blood vessels. The aim of this study was to investigate the efficacy of tadalafil on vessels endothelial function, in patients with male LUTS symptoms associated with BPH.

METHODS

The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 81 BPH patients. The following male LUTS parameters: international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), voiding volume, max and mean voiding flow on voiding flowmetry examination and post-voiding residual urine (RU) were compared at 0, 1, 3, 6, and 12 months after a daily dose of 5 mg tadalafil. In addition, erectile function was evaluated by the sexual health inventory for men (SHIM) score and vessels endothelial function and peripheral neuropathy were assessed by the brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI), and vibration perception threshold (VPT) at 0, 3, 6, and 12 months after treatment.

RESULTS

The mean age of 81 patients was 66.4 ± 11.4 years old. Their prostate size was 30.2 ± 22.1 ml. Male LUTS parameters including IPSS, OABSS, and RU showed significant improvement from 1 to 12 months after tadalafil administration. Max and mean voiding flow was significantly increased at 6 months after tadalafil treatment. The SHIM score showed significant improvement after 3 months. Whilst, the results of baPWV also showed significant improvement from 3 to 12 months. ABI was also significantly improved at 6 months. However, there was no change in the VPT at any time point.

CONCLUSIONS

Tadalafil is effective for both male LUTS and ED. It is also shown that tadalafil improves baPWV, which we can conclude that higher vessels elasticity has been obtained. This major finding of this study shows that tadalafil has the potency to improve vessels endothelial dysfunction in patients with BPH.

The Efficacy of Tadalafil Daily vs on Demand in the Treatment of Erectile Dysfunction: A Systematic Review and Meta-analysis

We present a review comparing the use of tadalafil daily vs on-demand for erectile dysfunction. We examined randomized controlled trials and observational studies that examined the use of tadalafil for at least 8 weeks of follow-up with the primary outcome of International Index for Erectile Dysfunction-Erectile Function domain. Eight studies that examined the desired dosing regimens were identified. Of these, 6 studies included the primary end point of 12 weeks. Those patients taking tadalafil daily for 12 weeks scored on average 1.82 points higher in International Index for Erectile Dysfunction-Erectile Function domain scores, although the difference may not be clinically significant (Fig. 1).