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Varghese R, Digholkar G, Karsiya J, Salvi S, Shah J, Kumar D, Sharma R. PDE5 inhibitors: breaking new grounds in the treatment of COVID-19. Drug Metab Pers Ther 2023; 38:295-307. [PMID: 38167268 DOI: 10.1515/dmpt-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/30/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Despite the ever-increasing occurrences of the coronavirus disease (COVID-19) cases around the world, very few medications have been validated in the clinical trials to combat COVID-19. Although several vaccines have been developed in the past quarter, the time elapsed between deployment and administration remains a major impediment. CONTENT Repurposing of pre-approved drugs, such as phosphodiesterase 5 (PDE5) inhibitors, could be a game-changer while lessening the burden on the current healthcare system. Repurposing and developing phosphodiesterase 5 (PDE5) inhibitors could extrapolate their utility to combat the SARS-CoV-2 infection, and potentially aid in the management of the symptoms associated with its newer variants such as BF.7, BQ.1, BQ.1.1, XBB.1.5, and XBB.1.16. SUMMARY Administration of PDE5 inhibitors via the oral and intravenous route demonstrates other potential off-label benefits, including anti-apoptotic, anti-inflammatory, antioxidant, and immunomodulatory effects, by intercepting several pathways. These effects can not only be of clinical importance in mild-to-moderate, but also moderate-to-severe SARS-CoV-2 infections. This article explores the various mechanisms by which PDE5 inhibitors alleviates the symptoms associated with COVID-19 as well as well as highlights recent studies and findings. OUTLOOK These benefits of PDE5 inhibitors make it a potential drug in the physicians' armamentarium in alleviating symptoms associated with SARS-CoV-2 infection. However, adequate clinical studies must be instituted to eliminate any untoward adverse events.
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Affiliation(s)
- Ryan Varghese
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gargi Digholkar
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
| | - Jainam Karsiya
- River Route Creative Group LLP, Mumbai, Maharashtra, India
| | - Sahil Salvi
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
| | - Jeenam Shah
- Department of Pulmonology, Saifee Hospital, Girgaon, Mumbai, Maharashtra, India
| | - Dileep Kumar
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
- Department of Entomology, University of California, Davis, CA, USA
- UC Davis Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Rohit Sharma
- Department of Rasa Shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Varghese R, Digholkar G, Karsiya J, Salvi S, Shah J, Kumar D, Sharma R. PDE5 inhibitors: breaking new grounds in the treatment of COVID-19. Drug Metab Pers Ther 2023; 0:dmdi-2023-0011. [PMID: 37608528 DOI: 10.1515/dmdi-2023-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Despite the ever-increasing occurrences of the coronavirus disease (COVID-19) cases around the world, very few medications have been validated in the clinical trials to combat COVID-19. Although several vaccines have been developed in the past quarter, the time elapsed between deployment and administration remains a major impediment. CONTENT Repurposing of pre-approved drugs, such as phosphodiesterase 5 (PDE5) inhibitors, could be a game-changer while lessening the burden on the current healthcare system. Repurposing and developing phosphodiesterase 5 (PDE5) inhibitors could extrapolate their utility to combat the SARS-CoV-2 infection, and potentially aid in the management of the symptoms associated with its newer variants such as BF.7, BQ.1, BQ.1.1, XBB.1.5, and XBB.1.16. SUMMARY Administration of PDE5 inhibitors via the oral and intravenous route demonstrates other potential off-label benefits, including anti-apoptotic, anti-inflammatory, antioxidant, and immunomodulatory effects, by intercepting several pathways. These effects can not only be of clinical importance in mild-to-moderate, but also moderate-to-severe SARS-CoV-2 infections. This article explores the various mechanisms by which PDE5 inhibitors alleviates the symptoms associated with COVID-19 as well as well as highlights recent studies and findings. OUTLOOK These benefits of PDE5 inhibitors make it a potential drug in the physicians' armamentarium in alleviating symptoms associated with SARS-CoV-2 infection. However, adequate clinical studies must be instituted to eliminate any untoward adverse events.
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Affiliation(s)
- Ryan Varghese
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, Kharghar, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gargi Digholkar
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
| | - Jainam Karsiya
- River Route Creative Group LLP, Mumbai, Maharashtra, India
| | - Sahil Salvi
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
| | - Jeenam Shah
- Department of Pulmonology, Saifee Hospital, Girgaon, Mumbai, Maharashtra, India
| | - Dileep Kumar
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune, Maharashtra, India
- Department of Entomology, University of California, Davis, CA, USA
- UC Davis Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Rohit Sharma
- Department of Rasa Shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abdel-Hamid IA, Abo-Aly M, Mostafa T. Phosphodiesterase type 5 inhibitors and premature ejaculation: an overview of systematic reviews/meta-analyses using the AMSTAR 2, ROBIS, and GRADE tools. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Introduction
The place of phosphodiesterase type 5 inhibitors (PDE5-Is) in treating premature ejaculation (PE) remains a therapeutic challenge.
Objectives
(1) To summarize the evidence of the efficacy and safety of PDE5-Is from published systematic reviews/meta-analyses (SRs/MAs). (2) To evaluate the reporting, methodological quality, and evidence quality of SRs/MAs concerning PE.
Methods
Nine databases were searched to retrieve SRs/MAs on using PDE5-Is for PE from inception to July 2022. Methodological quality and risk of bias were assessed with the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) and ROBIS (Risk of Bias in Systematic Reviews). GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluations) were used to assess the evidence quality.
Results
The literature search revealed 15 relevant SRs/MAs covering 28 primary studies (9 pairwise MAs and 6 network MAs) rated as low or very low quality and high risk of bias except 1 review that was rated as moderate quality and low risk of bias. Among the 27 outcome measures related to efficacy and safety, the quality of evidence according to GRADE criteria was low in 4 and critically low in 23. Oral PDE5-Is have demonstrated a possible benefit over placebo in lifelong PE and mixed PE. The results of pairwise and network MAs advocated that the combined use of PDE5-Is and SSRIs is of possible benefit as compared with either SSRIs or PDE5-Is alone. The total adverse effects were more frequent with PDE5-Is than placebo.
Conclusion
PDE5-Is are of a possible benefit than placebo in lifelong PE and mixed PE. The results favor coadministration of PDE5-Is plus SSRIs over SSRIs alone or PDE5-I monotherapy. These conclusions should be interpreted cautiously due to the low methodological quality and low quality of evidence of most available reviews. Additional higher-quality randomized controlled trials, SRs, and MAs are warranted to provide a better estimate of any effect size.
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Affiliation(s)
- Ibrahim A Abdel-Hamid
- Mansoura University Department of Andrology, Faculty of Medicine, , Mansoura 35516, Egypt
| | - Mohamed Abo-Aly
- Perelman School of Medicine Cardiovascular Division, Department of Medicine, , University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Taymour Mostafa
- Cairo University Department of Andrology and Sexology, Faculty of Medicine, , Cairo 11562, Egypt
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Colonnello E, Ciocca G, Limoncin E, Sansone A, Jannini EA. Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity. Nat Rev Urol 2021; 18:115-127. [PMID: 33442049 DOI: 10.1038/s41585-020-00417-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 01/29/2023]
Abstract
Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
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Affiliation(s)
- Elena Colonnello
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ciocca
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Clinical Psychosexology, Department of Dynamic and Clinical Psychology, University of Rome Sapienza, Rome, Italy
| | - Erika Limoncin
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Alotaibi FO, Alhakamy NA, Omar AM, El-Say KM. Clinical Pharmacokinetic Evaluation of Optimized Liquisolid Tablets as a Potential Therapy for Male Sexual Dysfunction. Pharmaceutics 2020; 12:pharmaceutics12121187. [PMID: 33297307 PMCID: PMC7762256 DOI: 10.3390/pharmaceutics12121187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 01/23/2023] Open
Abstract
The study aimed at developing a liquisolid tablet (LST) containing tadalafil (TDL) and dapoxetine (DPX) with improved bioavailability as a potential therapy for male sexual dysfunction. A mixture of nonvolatile solvents, namely PEG 200 and Labrasol®, was utilized to prepare LSTs that were assessed for their quality characteristics. The Box–Behnken design (BBD) was employed to statistically explore the effect of the formulation factors on the quality attributes of LSTs. Furthermore, an in vivo pharmacokinetic study was carried out for the optimized LST in comparison with the marketed tablets on healthy human volunteers. The optimized LST revealed acceptable quality limits with enhanced dissolution for both APIs. The pharmacokinetic parameters after oral administration of the optimized LST indicated that the Cmax of TDL in LSTs was 122.61 ng/mL within 2h compared to the marketed tablets, which reached 91.72 ng/mL after 3 h, indicating the faster onset of action. The AUC was improved for TDL in LST (4484.953 vs. 2994.611 ng/mL∙h in the marketed tablet) and DPX in LST (919.633 vs. 794.699 ng/mL∙h in the marketed tablet). This enhancement in bioavailability potentially minimizes the associated side effects and improves the treatment of male sexual dysfunction, particularly for diabetic patients.
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Affiliation(s)
- Fayez O. Alotaibi
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.O.A.); (N.A.A.)
| | - Nabil A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.O.A.); (N.A.A.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdelsattar M. Omar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Al-Azhar University, Cairo 11884, Egypt
| | - Khalid M. El-Say
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (F.O.A.); (N.A.A.)
- Center of Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence: ; Tel.: +96-658-293-4511
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Abstract
OBJECTIVE Premature ejaculation (PE) is regarded as one of the most common male sexual dysfunctions. This review introduced several pharmaceutical and surgical methods for the management of PE. The definition, etiology, behavioral, and psychological therapy of PE were also discussed. DATA SOURCES "Premature," "ejaculation," or "sexual dysfuction" were used as the medical subject headings (MeSH) to obtain relevant articles before June 2019 on Pubmed, Google Scholar and CNKI. Most articles used were written in English and several Chinese articles were also cited. STUDY SELECTION Full-text articles of retrospective/prospective/randomized controlled trials were analyzed. Animal experiments and letters were excluded. RESULTS There are four PE sub-types: lifelong PE, acquired PE, natural variable PE, and subjective PE. Behavioral therapy, psychotherapy, medication, topical anesthetics, and surgery are currently used for the treatment of PE. However, all the above treatments have limitations. Therefore, novel ways should be investigated to more efficiently control PE. CONCLUSIONS The pharmaceutical therapy that is currently being used in clinical practice for the management of PE is still the main choice globally due to its good efficacy. Surgery may be a choice for patients who are resistant to medication. However, it should be performed cautiously.
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Otani T. Clinical review of ejaculatory dysfunction. Reprod Med Biol 2019; 18:331-343. [PMID: 31607793 PMCID: PMC6780042 DOI: 10.1002/rmb2.12289] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ejaculatory dysfunction (EjD) is a complex pathological condition compared to erectile dysfunction (ED). A definitive classification of EjD is not established, and treatment is often delayed. Owing to its association with infertility, EjD is a serious concern, particularly in men of reproductive age. METHODS The authors performed a literature search to identify the latest articles and overseas guidelines for review. RESULTS Our new classification categorizes men into two groups as follows: (1) men with inability to ejaculate (retrograde ejaculation, anejaculation, intravaginal ejaculatory dysfunction) and (2) men requiring an abnormal time for ejaculation (premature ejaculation, delayed ejaculation). In Japan, the number of men presenting with an inability to ejaculate is greater than those presenting with premature ejaculation. Pharmacotherapy is the first-line treatment for the management of these EjD patients. Behavioral therapy is added to pharmacotherapy depending on the case. Penile vibratory stimulation or electroejaculation is indicated in some men with retrograde ejaculation and anejaculation. In cases who hope for a baby, assisted reproductive technology should be simultaneously considered not to waste time. CONCLUSION It is important to distinguish between EjD and ED and accurately diagnose the type of EjD for optimal treatment of this condition.
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Affiliation(s)
- Toshikazu Otani
- Department of UrologyRokuwa HospitalHeiwa Inazawa,AichiJapan
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Shin YS, Shin HS, Park JK. Lifestyle Modification Strategy for Patients with Premature Ejaculation as Metabolic Syndrome. World J Mens Health 2019; 37:372-373. [PMID: 31385472 PMCID: PMC6704304 DOI: 10.5534/wjmh.190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/09/2019] [Accepted: 05/26/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Hong Seok Shin
- Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
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Krishnappa P, Fernandez-Pascual E, Carballido J, Martinez-Salamanca JI. Sildenafil/Viagra in the treatment of premature ejaculation. Int J Impot Res 2019; 31:65-70. [DOI: 10.1038/s41443-018-0099-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/27/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022]
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Efficacy and safety of dapoxetine/sildenafil combination tablets in the treatment of men with premature ejaculation and concomitant erectile dysfunction-DAP-SPEED Study. Int J Impot Res 2019; 31:92-96. [PMID: 30705437 DOI: 10.1038/s41443-019-0122-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/29/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
Premature ejaculation (PE) and erectile dysfunction (ED) are the most prevalent sexual disorders in men. ED is commonly reported among patients with PE. Although recent guidelines recommend to treat ED first in men with both PE and ED, this recommendation is not based on evidence and there are limited data about the efficacy and safety of dapoxetine/sildenafil combination therapy for these patients. The aim of this study is to evaluate the clinical efficacy and safety of the dapoxetine/sildenafil combination (Dapoxil® 30/50 mg film-coated tablet) in the treatment of patients with PE and concomitant ED. In a single-center, single-arm, open-label clinical study conducted between October 2016 and September 2017, 74 patients with lifelong or acquired PE and ED were included. All patients were instructed to record their intravaginal ejaculatory latency time (IELT) with a stopwatch for 4 weeks. After the screening, they were requested to complete Premature Ejaculation Diagnostic Tool (PEDT), Premature Ejaculation Profile (PEP), and International Index of Erectile Function-Erectile Function (IIEF-EF) questionnaires before the treatment. The patients received on demand Dapoxil® 1-3 h before sexual intercourse for the next 4 weeks (2 days a week and no more than once a day). The patients were also assessed with global impression of change (GIC) question for the treatment satisfaction and the side effects were recorded. The study was completed with 53 patients (53/74, 71.62%). Mean age of the patients was 45.32 ± 10.05 years. At the end of the 4-week treatment period, the geometric mean IELT of the patients significantly increased (from 22.72 ± 15.16 to 68.25 ± 82.33 s; p < 0.001). Similarly, significant improvements were observed in the mean PEP index score (0.86 ± 0.72 vs. 2.36 ± 1.13; p < 0.001) and mean IIEF-EF domain score (13.17 ± 3.33 vs. 24.60 ± 3.96; p < 0.001). According to the GIC results, 81.13% of the patients were satisfied with the treatment. Non-serious adverse events occurred in 10 patients (18.87%) and 4 (7.55%) of these patients dropped out of the treatment. The most common adverse events were headache, palpitation, and flushing. The dapoxetine/sildenafil combination therapy significantly improves the IELT values and patient reported outcome measures of PE patients who also suffer from ED. Although several side effects were reported, these were mild and transient.
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Jin K, Deng L, Qiu S, Tu X, Li J, Bao Y, Yang L, Wei Q. Comparative efficacy and safety of phosphodiesterase-5 inhibitors with selective serotonin reuptake inhibitors in men with premature ejaculation: A systematic review and Bayesian network meta-analysis. Medicine (Baltimore) 2018; 97:e13342. [PMID: 30544399 PMCID: PMC6310608 DOI: 10.1097/md.0000000000013342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/29/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We performed the network meta-analysis (NMA) and systematic review involved all evidence from relevant trials to compare the efficiency and safety of various types of selective serotonin reuptake inhibitors (SSRI) and phosphodiesterase-5 inhibitors (PDE5i) in patients with premature ejaculation (PE). METHODS We conducted comprehensive searches of peer-reviewed and grey literature. PubMed, the Cochrane Library Central Register of Controlled Trials, Embase were searched for randomized controlled trials published up to June 1, 2017. The primary outcome was intravaginal ejaculation latency time (IVELT) and adverse effects (AEs). We performed pairwise meta-analyses by random effects model and network meta-analysis by Bayesian model. We used the GRADE framework to assess the quality of evidence contributing to each network estimate. RESULTS Of 3046 titles and abstracts initially identified, 17 trials reporting 5739 participants were included. Considering IVELT in the NMA, paroxetine plus sildenafil and sildenafil alone are both superior to placebo (MD: 1.75, 95% CrI: 0.05 to 3.78; MD 1.43, 95% CrI 0.003 to 2.81). Sildenafil is superior to sertraline (MD: 1.63, 95% CrI: 0.10 to 2.79). Considering AEs, placebo demonstrated obviously lower risk comparing to paroxetine, sildenafil and paroxetine plus sildenafil (OR 0.20, 95% CI: 0.05 to 0.52; OR 0.23, 95% CI: 0.04 to 0.80; OR 0.45, 95% CI: 0.01 to 0.92). Compared with tadalafil plus paroxetine, dapoxetine showed significantly less AEs (OR 0.23, 95% CI 0.02 to 0.96). CONCLUSIONS Our study concluded that although paroxetine plus sildenafil and sildenafil alone both demonstrated significant IVELT benefit compared with placebo, significant increase of AEs risk was also observed. Furthermore, sildenafil alone was superior to sertraline in efficacy with comparable tolerability.
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Affiliation(s)
- Kun Jin
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Linghui Deng
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Jiakun Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University
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12
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Li J, Liu D, Wu J, Fan X, Dong Q. Dapoxetine for the treatment of premature ejaculation: a meta-analysis of randomized controlled trials with trial sequential analysis. Ann Saudi Med 2018; 38:366-375. [PMID: 30284992 PMCID: PMC6180218 DOI: 10.5144/0256-4947.2018.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The safety and efficacy of dapoxetine for the treatment of premature ejaculation (PE) is still controversial. Thus, we decided to conduct a meta-analysis using trial sequential analysis (TSA) to determine the sufficiency of conclusions. OBJECTIVE Evaluate the efficacy and safety of dapoxetine in the treatment of patients with PE and assess the reliability of the findings. DESIGN Meta-analysis of randomized controlled trials (RCTs). METHODS Electronic databases including PUBMED, EMBASE, Cochrane Library, CNKI and Wanfang data were reviewed up to July 2017. RCTs evaluating the efficacy of dapoxetine in patients with PE and reporting intravaginal ejaculatory latency time (IELT), patient global impression of change (PGIC) and/or adverse events (AEs) were included. MAIN OUTCOME MEASURES Mean differences between trials in efficacy for IELT, and risk ratios for PGIC and treatment-emergent AEs. SAMPLE 8 RCTs. RESULTS For IELT and PGIC, significant effects were found for all doses of dapoxetine versus placebo, and similar results were obtained in subgroups of the 30-mg dose versus 60-mg dose. There were also statistically different dose-related effects on AEs. Trial sequential analysis showed that the result of our meta-analysis was confirmed and further trials are unnecessary. CONCLUSIONS The evidence suggests that dapoxetine may be a safe and effective drug for patients with PE. REGISTRATION Not registered, no published protocol. CONFLICT OF INTEREST No relationship with manufacturer of drug.
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Affiliation(s)
- Jing Li
- Dr. Jing Li, Department of Urology,, Xinxiang Central Hospital,, Xinxiang 453000, China, T: +8613462286403, , ORCID: http:// orcid.org/0000-0003-3030-354X
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Zhao Q, Dai H, Gong X, Wang L, Cao M, Li H, Wang B. Acupuncture for premature ejaculation: Protocol for a systematic review. Medicine (Baltimore) 2018; 97:e11980. [PMID: 30170398 PMCID: PMC6392721 DOI: 10.1097/md.0000000000011980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Premature ejaculation is a common sexual dysfunction disease in adult males. It can be divided into primary and secondary premature ejaculation. Acupuncture is widely used in the treatment of premature ejaculation in China. There are many clinical trials confirmed that acupuncture can prolong the ejaculation latency in the vagina. We aim to use a meta-analysis to evaluate the efficacy and safety of acupuncture for premature ejaculation. METHOD We will systematically search all randomized controlled trials (RCTs) by electronic and manual search, until June 31, 2018. Electronic retrieval of the database includes Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, the Cochrane Library, the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal database (VIP), and the Wanfang database. Manual search will retrieve gray literature, including unpublished conference articles. The primary outcomes include the Intravaginal Ejaculatory Latency Time (IELT). At the same time, Premature Ejaculation Diagnostic Tool (PEDT), Arabic index of Premature Ejaculation (AIPE), Index of Premature Ejaculation (IPE) will be the secondary outcomes. Two reviewers will independently read the articles, extract the data information, and give the assessment of risk of bias. Data analysis will be used the special software like RevMan (version 5.3) and EndNote X7. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of acupuncture for premature ejaculation. This review does not require ethical approval and will be reported in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018092783.
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Affiliation(s)
- Qi Zhao
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Hengheng Dai
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Xihao Gong
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Lu Wang
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Minran Cao
- Graduate School of Beijing University of Chinese Medicine
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital, Beijing, China
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Avasthi A, Grover S, Sathyanarayana Rao TS. Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian J Psychiatry 2017; 59:S91-S115. [PMID: 28216788 PMCID: PMC5310110 DOI: 10.4103/0019-5545.196977] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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15
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Comparison between on-demand use of sertraline and dapoxetine for treating patients with premature ejaculation. ACTA ACUST UNITED AC 2016. [DOI: 10.1097/01.xha.0000510703.23703.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Hong JH, Kwon YS, Kim IY. Pharmacodynamics, pharmacokinetics and clinical efficacy of phosphodiesterase-5 inhibitors. Expert Opin Drug Metab Toxicol 2016; 13:183-192. [PMID: 27690667 DOI: 10.1080/17425255.2017.1244265] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line drugs in the management of erectile dysfunction (ED). However, over the past two decades tremendous efforts have been made to identify new clinical uses of PDE5Is beyond their roles in ED. Areas covered: Basic science articles, clinical trials, reviews, and meta-analysis published between 1996 and 2015 were searched using MEDLINE (PubMed interface) to collect the most relevant and impactful studies from our perspectives as practicing urologists. This review mainly focuses on the level one evidence-based clinical efficacy and drug-related toxicity of oral PDE5Is. In addition, drug discovery, pharmacokinetics and pharmacodynamics, potential use in other diseases, and future directions are discussed. Expert opinion: On-demand PED5Is for the treatment of ED has shifted toward chronic administration in a broad spectrum of conditions that are thought to be associated with endovascular health. Several studies have shown that PDE5Is may play a cardioprotective or neuroprotective role. Further studies are under way to verify beneficial effects of PDE5I in non-urological conditions.
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Affiliation(s)
- Jeong Hee Hong
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA.,b Department of Urology , Dankook University College of Medicine , Cheonan , South Korea
| | - Young Suk Kwon
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
| | - Isaac Yi Kim
- a Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology , Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
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17
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Han JL, Gandhi S, Bockoven CG, Narayan VM, Dahm P. The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality. BJU Int 2016; 119:638-649. [DOI: 10.1111/bju.13653] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Julia L. Han
- Department of Urology; University of Florida; Gainesville FL USA
| | | | | | - Vikram M. Narayan
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
| | - Philipp Dahm
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
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18
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Current therapies for premature ejaculation. Drug Discov Today 2016; 21:1147-54. [DOI: 10.1016/j.drudis.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/01/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022]
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19
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Bai Y, Pu C, Han P. Reply: To PMID 26247816. Urology 2015; 86:765. [PMID: 26343234 DOI: 10.1016/j.urology.2015.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yunjin Bai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunxiao Pu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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20
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Gokce A. Editorial Comment. Urology 2015; 86:764-5. [PMID: 26343237 DOI: 10.1016/j.urology.2015.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmet Gokce
- Department of Urology, Sakarya University School of Medicine, Sakarya, Turkey
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