Choice between three phosphodiesterase type 5 inhibitors (PDE-5). A study of preference among patients with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED)

Abstract

Background. At present, three PDE5 are available for the treatment of erectile dysfunction: sildenafil, vardenafil and tadalafil. All share common mechanism of action but tadalafil is characterized by longer period of effectiveness. In the aim of this study was to assess the preferences concerning particular PDEPI ’s among patients with BPH and ED.
Material and methods. 39 men with clinically moderately advanced BPH successfully treated with doxazosin (n = 21) and tamsulosin (n = 18) for over one year and presenting with ED were enrolled. Their age ranged from 41 to 70 years (mean 57 yrs.: 19 aged ≤ 60 yrs. and 20 > 60 yrs.). All had moderate ED (Sexual Health Inventory for men - IIEF-5 - score 16-18 and Sexual Quotient score 41-60 points). This three-way cross-over open label consisted of three 6 weeks periods, including 4 weeks of drug administration (either sildenafil 50 mg, vardenafil 10 mg and tadalafil 10 mg, in single doses) and 2 weeks washout. At the end of each 6 study weeks periods patients were assessed (clinical examination, IIEF-5 and SQ scoring) and crossed over to another drug arm for futher 6 weeks and after total of 18 weeks completed the study and filled in a treatment preference questionnaire. The tolerability of treatments was also evaluated.
Results. In the group of 39 patients 22 (56%) indicated tadalafil as the preferred modality; 9 (23%) vardenafil and 6 (15%) sildenafil. Additionally, one patient found vardenafil and tadalafil to be equivalent and another one vardenafil and sildenafil to be equally preferred. The patient preferences did not depend on the age or the type of alpha-blocker administered. All medications were well tolerated. Adverse events were infrequent, observed with all the three PDE-5 and included headache, nasal congestion, flushing and diplopia.
Conclusions. 1. Tadalafil was clearly the most frequently preferred drug in BPH patients with moderate ED. 2. All the three evaluated PDE5 were well tolerated and the adverse reactions were mild and infrequent.