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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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2
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Jannini TB, Lorenzo GD, Bianciardi E, Niolu C, Toscano M, Ciocca G, Jannini EA, Siracusano A. Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs). Curr Neuropharmacol 2022; 20:693-712. [PMID: 33998993 PMCID: PMC9878961 DOI: 10.2174/1570159x19666210517150418] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.
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Affiliation(s)
- Tommaso B. Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio D. Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy;,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,Address correspondence to this author at the Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; E-mail:
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3
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Zhou Z, Yang Z, Cui Y, Zhang X, Wang Y, Zhang Y. The network meta-analysis of "on-demand" and "daily" use of paroxetine in treating men with premature ejaculation from randomized controlled trials. Andrologia 2022; 54:e14388. [PMID: 35122448 DOI: 10.1111/and.14388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
This network meta-analysis aimed to assess the efficacy and safety of "on-demand" and "daily" use of paroxetine for patients with premature ejaculation (PE). We searched PubMed, Embase and Cochrane Library from inception to October 2021 to collect randomized controlled trials, and 24 articles including 2, 308 patients were finally involved. The results indicated that paroxetine (daily or on-demand) was superior to placebo at increasing intravaginal ejaculatory latency time (IELT), and 20 mg paroxetine daily was significantly better than fluoxetine and tramadol in improving IELT. Besides, 20 mg paroxetine on-demand was less effective than 20 mg paroxetine on-demand plus phosphodiesterase-5 inhibitors (PDEI5) and tramadol monotherapy in increasing IELT. Tramadol monotherapy was more effective than paroxetine monotherapy in improving sexual satisfaction score. Although patients treated with paroxetine had more coitus/week than patients treated with placebo, it was less than patients treated with PDEI5. These findings were robust to sensitivity analyses. The common adverse events related with paroxetine were fatigue, yawning and abnormal sleep (10.96%), gastrointestinal upset (10.80%). The "on-demand" and "daily" use of paroxetine can significantly improve the clinical symptoms of patients with PE and were well tolerated. Combination therapy and tramadol monotherapy can also be used as alternative treatments.
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Affiliation(s)
- Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Zhenpeng Yang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yuanshan Cui
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Xiaoyi Zhang
- Department of Urology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yongqiang Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
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4
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Mitsogiannis I, Dellis A, Papatsoris A, Moussa M. An up-to-date overview of the pharmacotherapeutic options for premature ejaculation. Expert Opin Pharmacother 2022; 23:1043-1050. [PMID: 35108136 DOI: 10.1080/14656566.2022.2035361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Premature ejaculation (PE) is a sexual dysfunction of unknown etiology affecting a substantial number of males and deteriorating sexual health and quality of life of the patient and his partner. Treatment still remains challenging; however, pharmacotherapy is considered the mainstay of therapy with behavioral and psychosexual interventions being particularly important as adjudicate procedures, within the context of a holistic approach. AREAS COVERED The authors review the literature on the available medications for PE, both officially registered and non-registered. Currently, only dapoxetine and an anesthetic spray containing lidocaine and prilocaine (Fortacin™) are officially approved, with the rest being used off-label. Herein, updated data regarding the efficacy and safety of the pharmaceutical agents are presented. EXPERT OPINION On-demand dapoxetine is reportedly efficacious and safe in treating lifelong PE and is the first medication to be approved for this purpose. Fortacin has also shown considerable efficacy and may be reliably used on-demand. Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are therefore recommended either as monotherapy or combined with other therapies (i.e. dapoxetine). Adverse events of any therapy should be taken under consideration. Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment.
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Affiliation(s)
- Iraklis Mitsogiannis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamd Moussa
- Department of Urology, Al-Zahraa University Medical Center, Beirut, Lebanon
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5
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Saleh R, Majzoub A, Abu El-Hamd M. An update on the treatment of premature ejaculation: A systematic review. Arab J Urol 2021; 19:281-302. [PMID: 34552780 PMCID: PMC8451625 DOI: 10.1080/2090598x.2021.1943273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To analyse the current therapeutic options for patients with premature ejaculation (PE) and highlight their mechanism(s) of action, effectiveness, advantages and limitations. A literature search was conducted using the PubMed database searching for articles exploring different PE treatment modalities. A Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) approach was used to report the results of the literature search. A total of 149 articles were included in this review. The currently available treatment methods for PE include behavioural therapy, local anaesthetics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective phosphodiesterase inhibitors. Most PE treatments are either experimental or used off-label. New treatments are certainly warranted to overcome this exasperating sexual dysfunction.
Abbreviations: AIPE: Arabic Index of Premature Ejaculation; CNS: central nervous system; CYP: cytochrome P450; ED: erectile dysfunction; FDA: United States Food and Drug Administration; H1: histamine receptors; 5-HT: 5-hydroxytryptamine; IELT: The intravaginal ejaculation latency time; IPE: Index of Premature Ejaculation; M1: muscarinic receptors; OCD: obsessive–compulsive disorder; PDE5: phosphodiesterase type 5; PE: premature ejaculation; PEP: Premature Ejaculation Profile; PRO: patient-reported outcome; RCT: randomised controlled trial; SS: Severance Secret (cream); SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants
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Affiliation(s)
- Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmad Majzoub
- Urology Department, Hamad Medical corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Sathianathen NJ, Hwang EC, Mian R, Bodie JA, Soubra A, Lyon JA, Sultan S, Dahm P. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. Cochrane Database Syst Rev 2021; 3:CD012799. [PMID: 33745183 PMCID: PMC8094926 DOI: 10.1002/14651858.cd012799.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. OBJECTIVES To assess the effects of SSRIs in the treatment of PE in adult men. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. DATA COLLECTION AND ANALYSIS Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. MAIN RESULTS We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs. SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs. Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs. SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs. SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs. SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence). AUTHORS' CONCLUSIONS SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.
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Affiliation(s)
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Ruma Mian
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joshua A Bodie
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayman Soubra
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jennifer A Lyon
- Library Services, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Shahnaz Sultan
- Gastroenterology Section III-D, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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7
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Abdelshakour MA, Abdel Salam RA, Hadad GM, Abo-ElMatty DM, Abdel Hameed EA. HPLC-UV and UPLC-MS/MS methods for the simultaneous analysis of sildenafil, vardenafil, and tadalafil and their counterfeits dapoxetine, paroxetine, citalopram, tramadol, and yohimbine in aphrodisiac products. RSC Adv 2021; 11:8055-8064. [PMID: 35423308 PMCID: PMC8695090 DOI: 10.1039/d0ra10324a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/03/2021] [Indexed: 12/03/2022] Open
Abstract
In recent times, the counterfeiting of pharmaceuticals has been considered a serious trouble especially in developing countries that acquire poor inspection programs. Sildenafil, vardenafil and tadalafil (phosphodiesterase type 5 inhibitors) products have gained wide popularity in treating sexual disorders, for which they are subjected to counterfeiting. For this purpose, a simple, rapid, and novel HPLC method with ultraviolet detection has been simply developed for the simultaneous determination of vardenafil, sildenafil, and tadalafil, and their counterfeits (dapoxetine, paroxetine, citalopram, tramadol and yohimbine) in pharmaceutical dosage forms and counterfeit products such as instant coffee and honey. The separation was carried out on a C18 column, with acetonitrile and an aqueous 0.05% formic acid solution as the mobile phase with a gradient program and at a flow rate of 1 mL min-1. UV detection was accurately set at 230 nm. The total run time was 11 min for elution of these eight drugs. A UPLC-MS/MS method was also developed, by which compounds were separated in only 6 min, and it was used as a confirmatory tool for studied compounds by identification of their mass spectra. Proposed methods were validated by following ICH guidelines. Both methods were found to be linear, specific, precise and accurate, and they were efficiently applied to analyze 50 commercial products including honey sachets, instant coffee and pharmaceutical products marketed as aphrodisiacs and suspected to contain PDE5-inhibitors.
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Affiliation(s)
| | - Randa A Abdel Salam
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University Ismailia Egypt
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Sinai University, Kantara Branch Egypt
| | - Ghada M Hadad
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Suez Canal University Ismailia Egypt
| | - Dina M Abo-ElMatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University Ismailia Egypt
| | - Eman A Abdel Hameed
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Port Said University Egypt +20-64-3561877 +20-01224448268
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8
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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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9
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Ala M, Mohammad Jafari R, Dehpour AR. Sildenafil beyond erectile dysfunction and pulmonary arterial hypertension: Thinking about new indications. Fundam Clin Pharmacol 2020; 35:235-259. [PMID: 33226665 DOI: 10.1111/fcp.12633] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
Sildenafil, approved two decades ago, is the inhibitor of phosphodiesterase 5 (PDE5). First of all, it was designated for angina pectoris, but soon it showed a wonderful efficacy in erectile dysfunction (ED) and then pulmonary arterial hypertension (PAH). Due to the distribution of phosphodiesterase (PDE) in almost all organs, maybe it effects other diseases. Hence, a great number of investigations began to understand the role of PDEi in different organs. Preliminary research on sildenafil in cell culture and animal models has yielded promising results. Soon, a greater number of animal researches and clinical trials joined them. The results disclosed sildenafil can have beneficial effects in each organ such as heart, liver, kidney, brain, and intestines. Furthermore, it has significantly improved the prognosis of organ ischemia in various animal models. Clinical trials in several diseases, such as recurrent spontaneous miscarriage, fatty liver disease, bronchopulmonary dysplasia (BPD), heart failure, and premature ejaculation (PE) brought promising results. Although some clinical trials are available on the effects of sildenafil on various diseases, further studies on humans are needed to consolidate the ultimate effects of sildenafil. The aim of this review was to describe the effects of sildenafil on each organ and explain its mechanisms of action. Further, other PDE inhibitors such as tadalafil and vardenafil have been briefly discussed in parts of this review.
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Affiliation(s)
- Moein Ala
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, 13145-784, Iran.,Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, 13145-784, Iran
| | - Razieh Mohammad Jafari
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, 13145-784, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, 13145-784, Iran.,Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, 13145-784, Iran
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10
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Sahan A, Cubuk A, Ozkaptan O, Toprak T, Ozcan T, Ertas K, Canguven O, Tarhan F. Comparison of the safety and efficacy of the on-demand use of sertraline, dapoxetine, and daily use of sertraline in the treatment of patients with lifelong premature ejaculation: A prospective randomised study. Andrologia 2020; 52:e13854. [PMID: 33113277 DOI: 10.1111/and.13854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 01/21/2023] Open
Abstract
This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]: <1 min; Arabic Index of Premature Ejaculation [AIPE] score: < 30) without secondary causes of PE, identified between March 2018 and May 2020. Patients were divided into 4 groups (30 patients per group) and treated for 8 weeks. Assessments were conducted using the AIPE form as a diagnostic tool. Sertraline (50 mg, daily; 196.7 ± 115.5 s) and sertraline (100 mg, OD; 173.3 ± 97.0 s) had similar IELT and AIPE scores. The latter groups had better results in comparison with sertraline (50 mg, OD; 100.5 ± 54.4 s) and dapoxetine (93.7 ± 53.5 s; p < 0.01). Sertraline (100 mg, OD) had a similar efficacy to that of sertraline (50 mg, daily) and was more effective than sertraline (50 mg, OD) and dapoxetine (30 mg, OD). Sertraline (100 mg, OD) can be considered in the treatment of lifelong PE treatment, having tolerable side effects.
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Affiliation(s)
- Ahmet Sahan
- Department of Urology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Alkan Cubuk
- Department of Urology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Orkunt Ozkaptan
- Department of Urology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Tuncay Toprak
- Department of Urology, Health Science University, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Tolga Ozcan
- Department of Urology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Kasım Ertas
- Department of Urology, School of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Onder Canguven
- Department of Urology, General Hamad Hospital, Doha, Qatar
| | - Fatih Tarhan
- Department of Urology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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11
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Liu H, Zhang M, Huang M, Cai H, Zhang Y, Liu G, Deng C. Comparative efficacy and safety of drug treatment for premature ejaculation: A systemic review and Bayesian network meta-analysis. Andrologia 2020; 52:e13806. [PMID: 32892379 DOI: 10.1111/and.13806] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022] Open
Abstract
To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.
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Affiliation(s)
- Hanchao Liu
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingxiao Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingchuan Huang
- Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongcai Cai
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadong Zhang
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guihua Liu
- Reproductive Medicine Center, the Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunhua Deng
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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12
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Zhang X, Chi N, Sun M, Shan Z, Zhang Y, Cui Y. Phosphodiesterase-5 Inhibitors for Premature Ejaculation: Systematic Review and Meta-Analysis of Placebo-Controlled Trials. Am J Mens Health 2020; 14:1557988320916406. [PMID: 32375542 PMCID: PMC7233005 DOI: 10.1177/1557988320916406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A comprehensive search was performed to ascertain from trials about PDE5Is for the treatment of PE and compare the results, including intravaginal ejaculatory latency time (IVELT), score of sexual satisfaction scale, and side effects, between the group treated with PDE5Is and that treated with placebo. Seven studies involving a total of 471 patients were included in this meta-analysis. This analysis showed that patients who were treated with PDE5Is had significantly increased IVELT (mean difference [MD] 2.60; 95% CI [1.85, 3.36]; p < .00001) and score of sexual satisfaction scale (MD 2.04; 95% CI [0.78, 3.30]; p = .002) compared with the group on placebo. More patients had side effects while taking PDE5Is, such as headache, dizziness, flushing, and nasal congestion. PDE5Is were significantly more effective than placebo in the treatment of PE. Side effects were more common among patients who were treated with PDE5Is.
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Affiliation(s)
- Xuebao Zhang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Nan Chi
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Miao Sun
- Pharmaceutical Analysis Laboratory, Shandong Qidu Pharmaceutical Co., Ltd, Zibo, China
| | - Zhengfei Shan
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yulian Zhang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, China
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13
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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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Alghobary M, Gaballah M, El-Kamel MF, State AF, Ismail SR, Selim MK, Mostafa T. Oral dapoxetine versus topical lidocaine as on-demand treatment for lifelong premature ejaculation: A randomised controlled trial. Andrologia 2020; 52:e13558. [PMID: 32153050 DOI: 10.1111/and.13558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 02/14/2020] [Indexed: 02/05/2023] Open
Abstract
This trial aimed to assess the efficacy of on-demand oral dapoxetine versus topical lidocaine treatments for lifelong PE. Cases with lifelong PE were randomised to start treatment by oral dapoxetine 60 mg or topical lidocaine 10% spray. The intravaginal ejaculatory latency time (ILET), validated Arabic Index for PE (AIPE), Sexual Health Inventory for Men (SHIM) and frequency of intercourse/week were recorded at the baseline and after 12 weeks treatment period of the first medication before two weeks washout period and then crossing over to the other one for another 12 weeks. Results showed that both medications significantly increased both IELT and AIPE scores compared with the baseline being significantly better with topical lidocaine (63.44 s, 179.4 s versus 21.87 s, p < .05). Significant decrease of SHIM score was recorded with lidocaine but not with dapoxetine. Global Efficacy Question for the patient's assessment of the effectiveness of drugs showed that lidocaine was described as being effective by 43 cases and ineffective by 12 cases, oral dapoxetine was described as being effective by 16 cases and ineffective by 39 cases. From these accumulated data, it is concluded that topical lidocaine is more effective on-demand therapy for lifelong PE compared with oral dapoxetine.
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Affiliation(s)
- Moheiddin Alghobary
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Gaballah
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed F El-Kamel
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed F State
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif R Ismail
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed K Selim
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Premature Ejaculation: Aetiology and Treatment Strategies. Med Sci (Basel) 2019; 7:medsci7110102. [PMID: 31731516 PMCID: PMC6915345 DOI: 10.3390/medsci7110102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society for Sexual Medicine (ISSM) definition of PE, which includes reduced ejaculatory latency, lack of control and associated negative personal consequences. Patient assessment and management options differ depending on the classification of PE and it is the role of the clinician to appropriately classify patients and be aware of the correct management strategies. This review provides an overall background of PE in terms of classification and underlying physiology, patient assessment and management strategies along with the scientific rationale for treatment. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment in the form of selective serotonin re-uptake inhibitor dapoxetine, psychosexual behavioural therapy and psychological therapy.
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16
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Geng H, Peng D, Huang Y, Tang D, Gao J, Zhang Y, Zhang X. Changes in sexual performance and biochemical characterisation of functional neural regions: A study in serotonin transporter knockout male rats. Andrologia 2019; 51:e13291. [PMID: 31037750 DOI: 10.1111/and.13291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hao Geng
- Department of Urology The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Dangwei Peng
- Department of Urology The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Yuanyuan Huang
- Department of Urology The Fourth Affiliated Hospital of Anhui Medical University Hefei China
| | - Dongdong Tang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Jingjing Gao
- Department of Urology The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Yao Zhang
- Department of Urology The First Affiliated Hospital of Anhui Medical University Hefei China
| | - Xiansheng Zhang
- Department of Urology The First Affiliated Hospital of Anhui Medical University Hefei China
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17
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Safety and efficacy characteristics of oral drugs in patients with premature ejaculation: a Bayesian network meta-analysis of randomized controlled trials. Int J Impot Res 2019; 31:356-368. [DOI: 10.1038/s41443-019-0146-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/04/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023]
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18
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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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19
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Zhang D, Cheng Y, Wu K, Ma Q, Jiang J, Yan Z. Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis. BMC Urol 2019; 19:2. [PMID: 30606186 PMCID: PMC6318994 DOI: 10.1186/s12894-018-0431-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
Background Paroxetine is one of the selective serotonin reuptake inhibitors (SSRIs) used in the treatment of premature ejaculation (PE). However, this use is not approved in many countries. The purpose of this systematic review and meta-analysis is to review the efficacy and safety of paroxetine for PE patients. Methods We searched relevant randomized, controlled trials through May 2018, using PubMed, Embase and Cochrane Central Register. The main endpoint included intra-vaginal ejaculatory latency time (IELT) and side effects in the treatment of PE. Cochrane Collaboration’s Revman software, version 5.3, was used for statistical analysis. Results Out of 493 unique articles, a total of 19 randomized, controlled trials (RCTs) were reviewed. Quite a few RCTs were considered to have unclear risk of bias because of limited information. Pooled outcomes suggested that paroxetine was more effective than placebo, fluoxetine and escitalopram at increasing IELT (all p < 0.05). However, there existed a high level of heterogeneity in the paroxetine vs. fluoxetine groups and the paroxetine vs. placebo groups. Comparing paroxetine with tramadol, sertraline, phosphodiesterase 5 inhibitors (PDE5Is), local lidocaine gel, behaviour therapy or dapoxetine, we found that the increase in IELT was not statistically significant between groups. Paroxetine combined with tadalafil or behaviour therapy was more efficacious than paroxetine alone (all p < 0.05). Although the side effects in the combination group were more common than in the paroxetine alone group, the most common adverse events, such as nausea, muscle soreness, palpitation and flushing, were mild and tolerable. The main limitations of this systematic review and meta-analysis were the different definitions of PE and short follow-up times. Conclusions According to this systematic review and meta-analysis, paroxetine provided better efficacy than placebo, fluoxetine and escitalopram in the treatment of PE, with well-tolerated side effects. The combination group had better efficacy than the paroxetine alone group. Trial registration This review was reported in agreement with the PRISMA statement and was registered on PROSPERO 2018CRD42018097014.
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Affiliation(s)
- Dong Zhang
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Yue Cheng
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Kerong Wu
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Qi Ma
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Junhui Jiang
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China
| | - Zejun Yan
- Department of Urology & Nephrology, Ningbo First Hospital, The affiliated hospital of ZheJiang University, 59, Liuting Street, Ningbo, Zhejiang, China.
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20
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Jian Z, Wei X, Ye D, Li H, Wang K. Pharmacotherapy of premature ejaculation: a systematic review and network meta-analysis. Int Urol Nephrol 2018; 50:1939-1948. [PMID: 30225547 DOI: 10.1007/s11255-018-1984-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for premature ejaculation (PE). METHODS A systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for Systematic Reviews was performed on 1 March 2018. Intravaginal ejaculation latency time (IELT) was the main outcome. Analysis was performed under multivariate random-effects network model and efficacies of drugs were ranked with surface under the cumulative ranking (SUCRA) probabilities. RESULTS A total of 48 studies were reviewed and 40 of them were further enrolled into network meta-analysis. The majority of RCTs were of unclear methodological quality. Pooled evidence suggested that topical anaesthetic creams (TAs), tramadol, selective serotonin reuptake inhibitors (SSRIs), and phosphodiesterase type 5 inhibitors (PDE5is) are more effective at prolonging IELT comparing with placebo. TAs (90%) on demand (OD) and PDE5is plus SSRI (89.8%) had the highest SUCRA, which meant the most probable to be the most effective intervention. CONCLUSIONS We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better designed clinical trials rather than it is more effective than the other drugs studied. TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs. PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects. PDE5is OD can be recommended to PE patients with ED.
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Affiliation(s)
- Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Donghui Ye
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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21
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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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Sridharan K, Sivaramakrishnan G, Sequeira RP, Al-Khaja KA. Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials. Int J Impot Res 2018; 30:215-223. [PMID: 29921893 DOI: 10.1038/s41443-018-0030-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/25/2018] [Accepted: 04/01/2018] [Indexed: 12/28/2022]
Abstract
Premature ejaculation (PE) is the most common sexual dysfunction in men. The present study is a network meta-analysis of drugs used for treating PE. Electronic databases were searched for randomized controlled trials comparing medical interventions with either placebo or with other active drugs in patients with PE. Inverse variance heterogeneity model was used for mixed-treatment comparisons. Intravaginal ejaculatory latency time (IELT) and adverse events were the main outcome measures. A total of 44 studies were included in the meta-analysis. Dapoxetine 30 and 60 mg, tadalafil, sildenafil, paroxetine with sildenafil, topical lidocaine, dapoxetine 30 mg with mirodenafil, vardenafil, fluoxetine, and tadalafil, pindolol with paroxetine, tramadol, topical lidocaine with tadalafil, paroxetine with tadalafil, and topical eutectic mixture of local anesthetics were associated with a significant increase in IELT. Similarly, dapoxetine 60 mg, venlafaxine, fluoxetine, tramadol at 25, 50, and 100 mg, and combined fluoxetine and tadalafil were associated with an increased risk of adverse events. Dapoxetine 30 mg has a high likelihood of being the "best" in the interventional pool. Dapoxetine at 30 mg could be used as the first-line agent in the management of PE.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
| | - Gowri Sivaramakrishnan
- Department of Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Reginald P Sequeira
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khalid Aj Al-Khaja
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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