Dr. Debra Jaliman Media and Practice News
Is there a significant difference between the four available drugs for erectile dysfunction? According to Dr. Louis Liou, chief of urology at Harvard-affiliated Cambridge Health Alliance in Boston, the answer is yes. He states, “For new patients, I have them try different ones to see what works best.”
Direct Comparison of Tadalafil and Sildenafil for Erectile Dysfunction Treatment: A Comprehensive Review
Erectile dysfunction (ED) is a prevalent global health concern. Tadalafil and sildenafil, both phosphodiesterase 5 inhibitors, are commonly prescribed for ED treatment. This systematic review and meta-analysis aim to directly compare the effectiveness of tadalafil and sildenafil in managing ED.
Methods
A comprehensive search strategy was developed to explore the PubMed, Embase, EBSCO, Web of Science, and Cochrane Library databases. Additionally, reference lists of identified studies were screened. The review included all published randomized or non-randomized controlled trials that directly compared tadalafil and sildenafil for ED treatment. The quality of these studies was assessed, and data extraction was conducted. The meta-analysis was performed using RevMan 5.0.
Results
Sixteen trials, comparing tadalafil with sildenafil for ED treatment, were included in the meta-analysis. The analysis revealed that tadalafil and sildenafil had similar efficacies and overall adverse event rates. However, tadalafil outperformed sildenafil in improving psychological outcomes. Additionally, patients and their partners favored tadalafil over sildenafil. There was no significant difference in adherence and persistence rates between the two drugs. Tadalafil was associated with a higher rate of myalgia and back pain but a lower rate of flushing compared to sildenafil.
Conclusion
Tadalafil and sildenafil exhibit similar effectiveness and safety in ED treatment, with tadalafil offering enhanced psychological benefits and higher patient satisfaction. Thus, tadalafil may be a preferable choice for managing ED.
Introduction
Erectile dysfunction (ED) is characterized by the inability to achieve and sustain an erection sufficient for satisfactory sexual intercourse. This condition is among the most common sexual dysfunctions globally, affecting 5–20% of men, with prevalence rates varying worldwide. The estimated worldwide prevalence is expected to rise, potentially affecting 322 million men by 2025. Despite its benign nature, ED can have substantial physical, psychosocial, and quality-of-life repercussions for individuals and their partners.
Numerous treatment options are available for ED, including non-invasive and invasive modalities. Oral phosphodiesterase type 5 inhibitors (PDE5-Is) are the first-line therapy, simulating cyclic guanosine monophosphate (cGMP) and promoting penile erection. Four PDE5-Is, namely sildenafil, tadalafil, vardenafil, and avanafil, are approved by the US FDA. Sildenafil and tadalafil are the most commonly prescribed PDE5-Is worldwide.
Sildenafil, introduced in 1998, offers a quick onset of action (30 minutes), a duration of 4–6 hours, and a maximum effect duration of 12 hours. While effective, up to 50% of responders discontinue its use. Tadalafil, launched in 2003, features an onset of 20 minutes and should be taken 30 minutes before intercourse. It boasts the longest duration of action, up to 72 hours, with 52% of patients achieving successful intercourse within 30 minutes of consumption.
Recent systematic reviews and meta-analyses have examined the role of PDE5-Is, including sildenafil and tadalafil, in ED treatment. However, as most of these reviews were indirect comparative analyses, the distinctions between sildenafil and tadalafil remained unclear. This meta-analysis directly compares the two drugs to offer clinical guidance.
Materials and Methods
The search, conducted in January 2017, encompassed PubMed, EBSCO, Web of Science, Cochrane Library, and Embase databases. The terms “erectile dysfunction or sexual dysfunction” were combined with drug names, “tadalafil or Cialis” and “sildenafil or Viagra.” Additional relevant studies were identified by scrutinizing the references of selected papers and reviews. The search was not restricted by language, country, or publication year.
The systematic review included randomized or non-randomized controlled clinical trials comparing tadalafil and sildenafil. Studies had to provide relevant data for a meta-analysis, including the International Index of Erectile Function (IIEF)-EF domain, preference, and treatment-emergent adverse events (TEAEs). Jadad scores assessed the methodological quality, with a score of ≥3 indicating high quality.
Results
Of the 1657 articles identified, 16 studies met the inclusion criteria, encompassing 5189 patients. Patient ages ranged from 36.9 to 56.2 years. Seven studies were open-label, randomized, multicenter, controlled trials, nine had a crossover design, and others were prospective and observational. All studies compared sildenafil and tadalafil, evaluating various parameters including IIEF scores, patient preferences, SEAR, total EDITS scores, and TEAEs.
Conclusion
Tadalafil and sildenafil demonstrate similar effectiveness and safety for ED treatment, with tadalafil providing enhanced psychological benefits and higher patient satisfaction. Consequently, tadalafil may be the preferred choice for managing ED.
