Tian Daxue, Wang Xiao-Yan, Zong Huan-Tao, Zhang Yong
Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China.
Clin Interv Aging. 2017 Feb 20;12:405-412. doi: 10.2147/CIA.S122273. eCollection 2017.
We performed a meta-analysis to evaluate the efficacy and safety of short-term (≤6 months) and long-term (>6 months), regular (OaD) and on-demand (PRN) regimens of phosphodiesterase type 5 inhibitors (PDE5-Is) in treating erectile dysfunction (ED) after nerve-sparing radical prostatectomy (NSRP).
We conducted a literature search in August 2016. Sources included PubMed, EMBASE, and MEDLINE databases. The main outcome was International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, and the secondary outcome was treatment-emergent adverse events (TEAEs).
Eight articles involving 13 randomized controlled trials (RCTs) were used in this analysis: they suggested that PDE5-Is can improve the IIEF-EF distinctly in comparison with placebo in short and long term (mean difference [MD]: 2.26, 95% confidence interval [CI]: 1.45-3.08, <0.00001, and MD: 4.5, 95% CI: 3.6-5.4, <0.00001), and long-term use of PDE5-Is (>6 months) can improve the IIEF-EF distinctly in comparison with short-term use of PDE5-Is (≤6 months) (MD: 3.9, 95% CI: 3.01-4.8, <0.00001). OaD of PDE5-Is significantly improved the IIEF-EF compared to placebo in short and long term (MD: 4.08, 95% CI: 3.2-4.97, <0.00001, and MD: 4.74, 95% CI: 3.79-5.69, <0.00001). No significant differences were found in IIEF-EF changes between PRN and placebo (≤6 months) (MD: 2.64, 95% CI: -0.87 to 6.14, =0.14), and between PRN and OaD group (>6 months) (MD: -0.58, 95% CI: -9.86 to 8.74, =0.91). There were more TEAEs in PDE5-Is group in comparison with placebo (odds ratio [OR]: 1.55, 95% CI: 1.26-1.91, <0.0001), and TEAEs in OaD group were not significantly different from those seen in PRN group (OR: 1.05, 95% CI: 0.78-1.4, =0.77).
Our meta-analysis suggests that PDE5-Is are efficient and safe for treatment of ED after NSRP, and we should choose the regular regimen for short term and regular or on-demand regimen for long term. Further high-quality RCTs are needed to validate this result.
我们进行了一项荟萃分析，以评估5型磷酸二酯酶抑制剂（PDE5-Is）短期（≤6个月）和长期（>6个月）、规律（每日一次）和按需（必要时）给药方案治疗保留神经的根治性前列腺切除术（NSRP）后勃起功能障碍（ED）的疗效和安全性。
我们于2016年8月进行了文献检索。来源包括PubMed、EMBASE和MEDLINE数据库。主要结局是国际勃起功能指数-勃起功能（IIEF-EF）领域评分，次要结局是治疗中出现的不良事件（TEAEs）。
本分析纳入了8篇文章，涉及13项随机对照试验（RCTs）：结果表明，与安慰剂相比，PDE5-Is在短期和长期均能显著改善IIEF-EF（平均差值[MD]：2.26，95%置信区间[CI]：1.45-3.08，<0.00001；MD：4.5，95%CI：3.6-5.4，<0.00001），且与短期使用PDE5-Is（≤6个月）相比，长期使用PDE5-Is（>6个月）能显著改善IIEF-EF（MD：3.9，95%CI：3.01-4.8，<0.00001）。与安慰剂相比，PDE5-Is的规律给药在短期和长期均能显著改善IIEF-EF（MD：4.08，95%CI：3.2-4.97，<0.00001；MD：4.74，95%CI：3.79-5.69，<0.00001）。在按需给药与安慰剂（≤6个月）之间（MD：2.64，95%CI：-0.87至6.14，P=0.14）以及按需给药与规律给药组（>6个月）之间（MD：-0.58，95%CI：-9.86至8.74，P=0.91），IIEF-EF变化无显著差异。与安慰剂相比，PDE5-Is组的TEAEs更多（比值比[OR]：1.55，95%CI：1.26-1.91，<0.0001），且规律给药组的TEAEs与按需给药组无显著差异（OR：1.05，95%CI：0.78-1.4，P=0.77）。
我们的荟萃分析表明，PDE5-Is治疗NSRP术后ED有效且安全，短期应选择规律给药方案，长期应选择规律或按需给药方案。需要进一步的高质量RCT来验证这一结果。
