WHICH OF PDE5 INHIBITORS IS MOST EFFECTIVE IN THE TREATMENT OF ERECTILE DYSFUNCTION IN PATIENTS WITH SPINAL CORD INJURY? A NETWORK META-ANALYSIS

AbstractBackgroundPhosphodiesterase 5 inhibitors (PDE5i) are the first‐line drugs for erectile dysfunction (ED) but differences among available molecules should drive therapy personalization. Choosing one PDE5i over another is a challenge in men with spinal cord injury (SCI), as the evidence of efficacy for each molecule is derived from few studies and comparative “head‐to‐head” trials are lacking.ObjectiveTo assess the efficacy of the different PDE5i for SCI‐related ED with a network meta‐analysis (NMA) approach.Materials and methodsDatabases from PubMed, Web of Science, Scopus, and Cochrane Library were checked for randomized controlled trials (RCTs) comparing any PDE5i to each other or placebo in men with traumatic SCI lasting ≥6 months. Data were incorporated in a random‐effect NMA, where treatments’ efficacy was ranked using the surface under the cumulative ranking curve (SUCRA).ResultsThe 10 RCTs included provided information about 1,492 men with ED due to traumatic SCI. Intervention arms included sildenafil, tadalafil, and/or vardenafil. Overall, at the pairwise meta‐analysis, PDE5i were four times more effective than placebo in improving erectile function (risk ratio: 4.13, 95% CI: 2.76, 6.19). The comparative analysis from NMA revealed that tadalafil was associated with the highest SUCRA value (81%), followed by vardenafil (68%) and sildenafil (49%).Discussion and conclusionWithin the grading of comparison network, tadalafil appeared to be the best PDE5i in the treatment of SCI‐related ED. Further focused studies are warranted to confirm these findings and define optimal doses and duration of therapy.