Sildenafil improves erectile hardness in Chinese men with erectile dysfunction: a real-life study analyzed on age stratification

Validity of self-reported male sexual function scales in a young Chinese population: a comparative study with clinician-assisted evaluation

Psychometric scales, commonly used to gauge sexual function, can sometimes be influenced by response biases. In our research from June 2020 to April 2021, we examined the accuracy of self-reported sexual function scales. We invited patients from the Department of Infertility and Sexual Medicine at the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China), who have male sexual dysfunction, to participate by filling out a self-reported version of a specific questionnaire. In addition, they went through a clinician-assisted version of this questionnaire, encompassing tools such as the Premature Ejaculation Diagnostic Tool (PEDT), the 6-item International Index of Erectile Function (IIEF-6), the Erection Hardness Scale (EHS), and the Masturbation Erection Index (MEI). Using the clinician-assisted version as a reference, we categorized patients and applied various statistical methods, such as the Chi-square test, intraclass correlation coefficient (ICC), logistic regression, and the Bland-Altman plot, to gauge reliability. In our study with 322 participants, we found that while there were no notable discrepancies in error rates based on our categorization, certain scales showed significant differences in terms of overestimation and underestimation, with the exception of the PEDT. The positive diagnosis rate consistency between the self-reported and clinician-assisted versions was observed. High ICC values between the two versions across the scales were indicative of remarkable reliability. Our findings show that the self-reported versions of tools such as EHS, IIEF-6, MEI, and PEDT are credible and hold clinical reliability. However, employing a dual-diagnosis approach might be more prudent to circumvent potential misdiagnoses.

Sexual life and medication taking behaviours in young men: An online survey of 92 620 respondents in China

OBJECTIVES

To assess sexual life and medication taking behaviours in young Chinese men.

METHODS

An online survey was conducted across China between January 2017 and April 2017. Among the participants, men aged 19-40 years were included in the analysis. The respondents filled in the online questionnaire assessing sexual life and medication taking behaviours by themselves, including general information, cognition of erectile dysfunction (ED) and treatment-related questions. Erection hardness score (EHS) was used to measure the erection hardness status.

RESULTS

Among the young respondents, 20.54% had grade I-II EHS, 58.14% searched the internet for online ED-related information, 26.49% took an ED medication and 50.89% took an ED medication without the advice of a physician or pharmacist. The respondents who took medication had less sexual intercourse per week (P < .001) and worse EHS (P < .001), and were more willing to seek information from physicians, pharmacists, friends and relatives instead of online sources (P < .001), compared with those not taking medication. The most common comorbidities in patients with grade I-II EHS were hyperlipidaemia, cardiovascular disease (CVD), prostate diseases and diabetes mellitus.

CONCLUSION

About 20% of young Chinese men needed further assessment for ED. The majority of respondents obtained ED-related information by online search and took an ED medication without professional advice. These data could help clinicians understand the current status of sexual life and medication taking behaviours of young Chinese men.

[Assessment of the erectile function and patients' perception of improvement in Spanish patients with erectile dysfunction]

OBJECTIVE

This study has been carried out to assess the hardness of erection and the perception of improvement in erectile function with the treatments received during the last month.

MATERIAL AND METHOD

Descriptive, observational, multicenter, cross-sectional study carried out in 30 urology sites in Spain. Patients diagnosed of erectile dysfunction receiving treatment during at least the last month have been enrolled. Hardness of erection has been assessed with the erection hardness score and improvement perception has been estimated with the global assessment question.

RESULTS

A 63% of patients had a hardness of erection that was insufficient for penetration, but 75% of patients referred that their erectile function had improved with treatment. After adjustment for other factors, erection hardness score values were not significantly different among patients being treated with alprostadil topical cream, compared to patients being treated with the combination of phosphodiesterase 5 (PDE5) inhibitors plus alprostadil topical cream or with PDE5i other than sildenafil alone. However, patients treated with alprostadil topical cream had a significantly higher chance of referring an improvement in their erectile function compared to patients treated with PDE5i, despite the fact that they had received treatment for a shorter period of time.

CONCLUSION

Hardness of erection is just another factor of erectile function, but it is not the only one influencing improvement perception by patients.

Quality of erections by age group in men with erectile dysfunction

AIMS

The aim of this study was to assess erection quality with sildenafil vs placebo and adverse events (AEs) according to age (≤45, 46-55 and ≥56 years) in 997 men with erectile dysfunction (ED) using pooled data from four randomized, double-blind, placebo-controlled, flexible-dose trials.

METHODS

The trials included 6- to 10-week treatment periods. The starting sildenafil dose was 50 mg, taken ~1 hour before sexual activity but not more than once daily, with subsequent adjustment to 100 or 25 mg based on efficacy and safety. Exclusion criteria included blood pressure <90/50 or >170/110 mmHg, taking nitrate therapy or nitric oxide donors, severe cardiac failure/unstable angina or recent stroke or myocardial infarction. Changes from baseline in Quality of Erection Questionnaire (QEQ), International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores were analysed.

RESULTS

Improvements in QEQ scores with sildenafil vs placebo were significant (P<.0001) for the overall sample (33.7 sildenafil; 8.1 placebo) and each age group (≤45 years: 38.5 sildenafil, 13.9 placebo; 46-55 years: 34.9 sildenafil, 5.8 placebo; ≥56 years: 26.9 sildenafil, 4.9 placebo). IIEF Erectile Function domain (P<.0001), question 3 (achieving erection; P<.003), and question 4 (maintaining erection; P<.001) scores also improved significantly for the overall sample and each age group. Treatment satisfaction was significantly greater (P<.0001) with sildenafil vs placebo for the overall sample and each age group. The most common AEs with sildenafil were headache, flushing and nasal congestion in all age groups.

CONCLUSIONS

Sildenafil significantly improved erection quality across all age groups of men with ED. Efficacy improvements with sildenafil were consistent with the QEQ, IIEF, and EDITS. AEs were comparable across age groups. ClinicalTrials.gov ID: NCT00159900, NCT00147628, NCT00301262, NCT00343200.

Preclinical pharmacokinetics of TPN729MA, a novel PDE5 inhibitor, and prediction of its human pharmacokinetics using a PBPK model

AIM

TPN729MA is a novel selective PDE5 inhibitor currently under clinical development in China for the treatment of erectile dysfunction. In this study we characterized its preclinical pharmacokinetics (PK) and predict its human PK using a physiologically based pharmacokinetic (PBPK) model.

METHODS

The preclinical PK of TPN729MA was studied in rats and dogs. Human clearance (CL) values for TPN729MA were predicted from various allometric methods and from intrinsic CL determined in human liver microsomes. Human PK and plasma concentration versus time profiles of TPN729MA were predicted by using a PBPK model in GastroPlus. Considering the uncertainties in the prediction, a preliminary human study was conducted in 3 healthy male volunteers with an oral dose of 25 mg.

RESULTS

After a single intravenous administration of TPN729MA at a dose of 1 mg/kg in rats and 3 mg/kg in dogs, the plasma CL was 69.7 mL·min(-1)·kg(-1) in rats and 26.3 mL·min(-1)·kg(-1) in dogs, and the steady-state volumes of distribution (V(ss)) were 7.35 L/kg in rats and 6.48 L/kg in dogs. The oral bioavailability of TPN729MA was 10% in rats and above 34% in dogs. Profiles of predicted plasma concentration versus time were similar to those observed in humans at 25 mg, and the predicted T(max), C(max) and AUC values were within 2-fold of the observed values.

CONCLUSION

TPN729MA demonstrates good preclinical PK. This compound is a valuable candidate for further clinical development. This study shows the benefits of using a PBPK model to predict PK in humans.