Systematic review of randomised controlled trials of sildenafil (Viagra®) in the treatment of male erectile dysfunction.

Background: Sildenafil (Viagra®), a new oral drug for the treatment of erectile dysfunction, was licensed for use across Europe in 1998. Aim: To examine the effectiveness and safety of sildenafil as an oral treatment for erectile dysfunction. Design of study: Systematic review and meta-analysis.
Setting: All published or unpublished randomised controlled trials comparing sildenafil with a placebo or alternative therapies. Method: Published studies were sought by computerised searches of electronic databases using the keywords ‘sildenafil’ and ‘Viagra’. A hand search was also done of the British Medical Journal, Lancet, Journal of the American
Medical Association, New England Journal of Medicine, British Journal of General Practice, Drug, Inpharma and Scrip. An assessment of quality of all identified studies and data extraction was undertaken independently by two researchers. Results were combined in a meta-analysis where appropriate, using RevMan version 3. Results: Twenty-one trials were identified. All trials showed a statistically significant improvement in erectile or sexual function in patients using sildenafil compared with a placebo. A meta-analysis of 16 trials reporting a global efficacy response showed that men were 3.57 (95% CI = 2.93–4.43) times as likely to have improved erections on sildenafil compared with those on a placebo. The number needed to treat to have one man with improved erections was two. The drug has a relatively safe side-effect profile. Conclusions: Available research shows that sildenafil is an effective treatment for male erectile dysfunction. Many trial participants had some baseline erectile function and it is probable that in clinical practice, where the erectile function tends to be more impaired, the number needed to treat may be higher.

Investigating women's preference for sildenafil or tadalafil use by their partners with erectile dysfunction : the partners' preference study.

Introduction: Several preference studies comparing a short-acting with a longer-acting phosphodiesterase type 5 inhibitor have been conducted in men. Most men in those studies preferred tadalafil rather than sildenafil, and recent post hoc analysis of one study described several factors associated with men’s treatment preference. No prospective studies have investigated the woman partners’ preferences.

Aim: To investigate the treatment preference of women who were partners of men using oral medications for erectile dysfunction (ED) in a single-center open-label crossover study.

Methods: One hundred heterosexual couples in stable relationships, with male partners having ED based on the erectile function subscale of the International Index of Erectile Function, were randomly assigned to receive sildenafil or  tadalafil for a 12-week phase, followed by another 12-week period using the alternate drug. Male and female participants completed sexual event diaries during both study phases, and the female participants were interviewed at  baseline, midpoint, and end of study.

Main Outcome Measures: Primary outcome data were the women’s final  interviews during which they were asked which drug they preferred and their reasons for that preference.

Results: A total of 79.2% of the women preferred their partners’ use of tadalafil, while 15.6% preferred sildenafil. Preference was not affected by age or treatment order randomization. Women preferring tadalafil reported feeling more relaxed, experiencing less pressure, and enjoying a more natural or spontaneous sexual experience as reasons for their choice. Mean number of tablets used, events recorded, events per week, and days between events were not significantly different during each study phase.

Conclusion: Women’s preferences were similar to men when using these two drugs. While the women’s reasons for preferring tadalafil emphasized relaxed, satisfying, longer-lasting sexual experiences, those preferring sildenafil focused on satisfaction and drug effectiveness for their partner.

Effect of erectile dysfunction medications on coexsisting dysfunctions in couples : Partner's Preference Study

There is sparse information on how treatments for erectile dysfunction (ED) affects couples. This study investigated the effects of ED treatments on 100 heterosexual couples' sexual functioning and whether function achieved using a short-acting versus a long-acting ED medication differed significantly. Couples were randomized to use tadalafil or sildenafil for each of two 12-week study phases; they completed questionnaires (International Index of Sexual Function and Female Sexual Function Index) and kept sexual event diaries. All participants experienced significant improvements over baseline sexual functioning, while the men used short- or long-acting ED medications with no significant differences related to the duration of drug action recorded for either the men or women. Despite this lack of difference in efficacy there was a strong preference by women (79%) and their partners (16%) for the longer-acting medication. The reasons for this warrant further investigation. Understanding the effects on couples of the use of ED medications is a necessary aspect of ensuring ongoing sexual satisfaction in couples treated for ED.

Depression therapy: Future prospects.

Current biological approaches to the treatment of depression focus mainly on modification of monoaminergic neurotransmission. New agents targeting these neurotransmitters are under development. Many novel antidepressant targets are however under investigation. These include the neurokinins, glutamate, purinoceptors, opioids and trophic factors. While many of these potential targets are likely to fail clinical development, exciting novel therapeutic options are likely to emerge.