Mulhall John P, McLaughlin Trent P, Harnett James P, Scott Brian, Burhani Soraya, Russell David
Pfizer Inc, Albany, NY, USA.
J Sex Med. 2005 Nov;2(6):848-55. doi: 10.1111/j.1743-6109.2005.00149.x.
A number of preference studies have been conducted with phosphodiesterase type 5 (PDE5) inhibitor medications demonstrating inconsistent findings. Additionally, limited information is available regarding real-world utilization patterns of PDE5 inhibitors.
To evaluate treatment patterns using real-world data for patients initiating erectile dysfunction (ED) therapy with Viagra (sildenafil citrate), Levitra (vardenafil), or Cialis (tadalafil).
Patients with an initial prescription claim for sildenafil, vardenafil, or tadalafil were identified in NDCHealth's Intelligent Health Repository. Medication refills, medication switching, and dose titration were analyzed. Logistic regression on the odds of refilling initial PDE5 medications was conducted controlling for patient age, presence of common comorbidities, initial number of tablets, and copay.
A higher percentage of patients receiving sildenafil (52%) refilled their ED medication during the study period than patients receiving vardenafil (30%) or tadalafil (29%) (P<0.001). A smaller percentage of patients in the sildenafil cohort (6.4%) switched medication than in the tadalafil (9.0%) or vardenafil (10.4%) cohorts (P<0.001); the difference between the tadalafil and vardenafil cohorts in switching medications was also significant (P<0.001). There were no statistically significant differences between cohorts in dose titration frequency, which was low in all three treatment cohorts. Using logistic regression, the odds of refilling initial PDE5 therapy was significantly lower for vardenafil (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.38-0.40; P<0.0001) and tadalafil (OR: 0.38, 95% CI: 0.37-0.40; P<0.0001) compared with sildenafil.
Patients who were initially prescribed sildenafil were significantly more likely to refill their medication and significantly less likely to switch medications during the study period compared with patients who were initially prescribed vardenafil or tadalafil. These findings may indicate greater treatment satisfaction in patients receiving sildenafil, although future prospective evaluation is required.
已针对5型磷酸二酯酶（PDE5）抑制剂药物开展了多项偏好研究，结果并不一致。此外，关于PDE5抑制剂的实际使用模式的信息有限。
利用真实世界数据评估开始使用伟哥（枸橼酸西地那非）、艾力达（伐地那非）或希爱力（他达拉非）治疗勃起功能障碍（ED）的患者的治疗模式。
在NDCHealth的智能健康数据库中识别出首次开具西地那非、伐地那非或他达拉非处方的患者。分析药物再填充、药物转换和剂量滴定情况。对首次PDE5药物再填充的几率进行逻辑回归分析，同时控制患者年龄、常见合并症的存在、初始片剂数量和自付费用。
在研究期间，接受西地那非治疗的患者（52%）中再填充ED药物的比例高于接受伐地那非（30%）或他达拉非（29%）治疗的患者（P<0.001）。与他达拉非（9.0%）或伐地那非（10.4%）组相比，西地那非组中换药的患者比例更小（6.4%）（P<0.001）；他达拉非组和伐地那非组在换药方面的差异也具有统计学意义（P<0.001）。各治疗组在剂量滴定频率方面无统计学显著差异，所有三个治疗组的剂量滴定频率均较低。通过逻辑回归分析，与西地那非相比，伐地那非（优势比[OR]：0.39，95%置信区间[CI]：0.38 - 0.40；P<0.0001）和他达拉非（OR：0.38，95% CI：0.37 - 0.40；P<0.0001）首次PDE5治疗再填充的几率显著更低。
与最初开具伐地那非或他达拉非的患者相比，最初开具西地那非的患者在研究期间更有可能再填充药物，且换药的可能性显著更低。这些发现可能表明接受西地那非治疗的患者治疗满意度更高，不过仍需要未来进行前瞻性评估。
