Jian Zhongyu, Wei Xin, Ye Donghui, Li Hong, Wang Kunjie
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
Int Urol Nephrol. 2018 Nov;50(11):1939-1948. doi: 10.1007/s11255-018-1984-9. Epub 2018 Sep 17.
The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for premature ejaculation (PE).
A systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for Systematic Reviews was performed on 1 March 2018. Intravaginal ejaculation latency time (IELT) was the main outcome. Analysis was performed under multivariate random-effects network model and efficacies of drugs were ranked with surface under the cumulative ranking (SUCRA) probabilities.
A total of 48 studies were reviewed and 40 of them were further enrolled into network meta-analysis. The majority of RCTs were of unclear methodological quality. Pooled evidence suggested that topical anaesthetic creams (TAs), tramadol, selective serotonin reuptake inhibitors (SSRIs), and phosphodiesterase type 5 inhibitors (PDE5is) are more effective at prolonging IELT comparing with placebo. TAs (90%) on demand (OD) and PDE5is plus SSRI (89.8%) had the highest SUCRA, which meant the most probable to be the most effective intervention.
We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better designed clinical trials rather than it is more effective than the other drugs studied. TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs. PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects. PDE5is OD can be recommended to PE patients with ED.
本研究旨在对治疗早泄（PE）的不同常用处方药进行系统评价。
于2018年3月1日对MEDLINE、Cochrane对照试验中央注册库和Web of Science系统评价数据库进行了系统文献检索。阴道内射精潜伏期（IELT）为主要观察指标。采用多变量随机效应网络模型进行分析，并根据累积排序曲线下面积（SUCRA）概率对药物疗效进行排序。
共检索到48项研究，其中40项进一步纳入网络荟萃分析。大多数随机对照试验的方法学质量不明确。汇总证据表明，与安慰剂相比，局部麻醉乳膏（TAs）、曲马多、选择性5-羟色胺再摄取抑制剂（SSRIs）和5型磷酸二酯酶抑制剂（PDE5is）在延长IELT方面更有效。按需使用的TAs（90%）和PDE5is加SSRI（89.8%）的SUCRA最高，这意味着最有可能是最有效的干预措施。
我们推荐初始使用达泊西汀30mg按需治疗PE，这是因为它已在规模最大、设计更优的临床试验中得到验证，而非它比其他研究药物更有效。TAs和曲马多50mg按需治疗可作为口服SSRI治疗的可行替代方案。PDE5is与SSRI联合使用比SSRI单药治疗更有效，但也伴有更多副作用。PDE5is按需治疗可推荐给合并勃起功能障碍（ED）的PE患者。
