Wu Po-Chien, Hung Chun-Shan, Kang Yi-No, Wu Chien-Chih
Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Sex Med. 2021 Feb;9(1):100283. doi: 10.1016/j.esxm.2020.10.011. Epub 2020 Dec 5.
Clomipramine is effective in treating premature ejaculation, a common form of male sexual dysfunction that affects individual's mental health and quality of life, but its optimal dosage remains controversial.
In this systematic review and meta-analysis, we aimed to evaluate the efficacy, safety, and optimal dose of clomipramine for treating premature ejaculation among men.
Eligible studies of PubMed, Embase, and Web of Science were identified from the date of inception to June 21, 2020. We conducted the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data of the study characteristics, intravaginal latency ejaculatory time (IELT), adverse events, success rate, and satisfaction rate of clomipramine vs placebo were extracted and analyzed. The risk ratio and mean difference were used for quantitatively analyzing binary outcomes and continuous outcomes. The standardized mean difference was applied to the outcome of satisfaction rate. The Mantel-Haenszel method was used for meta-analysis under random-effects model. To assess dose effect of clomipramine, a meta-regression analysis was performed.
The primary outcomes were the IELT and adverse events, and the secondary outcomes were the success rate and satisfaction rate of clomipramine treatment relative to the placebo.
A total 14 randomized controlled trials with 710 patients were included for quantitative analysis. Clomipramine significantly increased the IELT compared with the placebo (mean difference: 1.47, 95% CI: 0.73-2.21). However, clomipramine was associated with higher risks of overall adverse events and adverse events in the nervous and respiratory systems. Significant dosage effects on the IELT (estimate: 0.0637, 95% CI: 0.0074-0.12) and a slightly increasing slope on adverse events were revealed.
Clomipramine increased the IELT and yielded greater satisfaction than the placebo, and the higher dose results in a superior IELT without leading to higher risk of adverse events under a dosage of 50-mg clomipramine. Wu P-C, Hung C-S, Kang Y-N, et al. Tolerability and Optimal Therapeutic Dosage of Clomipramine for Premature Ejaculation: A Systematic Review and Meta-Analysis. Sex Med 2021;9:100283.
氯米帕明对治疗早泄有效，早泄是男性性功能障碍的一种常见形式，会影响个人心理健康和生活质量，但其最佳剂量仍存在争议。
在本系统评价和荟萃分析中，我们旨在评估氯米帕明治疗男性早泄的疗效、安全性和最佳剂量。
从创刊至2020年6月21日，在PubMed、Embase和Web of Science中检索符合条件的研究。我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行研究。提取并分析氯米帕明与安慰剂的研究特征、阴道内射精潜伏期（IELT）、不良事件、成功率和满意率的数据。风险比和均值差用于定量分析二分类结局和连续型结局。标准化均值差应用于满意率结局。采用Mantel-Haenszel方法在随机效应模型下进行荟萃分析。为评估氯米帕明的剂量效应，进行了荟萃回归分析。
主要结局为IELT和不良事件，次要结局为氯米帕明治疗相对于安慰剂的成功率和满意率。
共纳入14项随机对照试验，710例患者进行定量分析。与安慰剂相比，氯米帕明显着延长IELT（均值差：1.47，95%CI：0.73 - 2.21）。然而，氯米帕明与更高的总体不良事件风险以及神经和呼吸系统不良事件风险相关。揭示了对IELT有显著的剂量效应（估计值：0.0637，95%CI：0.0074 - 0.12），且不良事件斜率略有增加。
氯米帕明延长了IELT，且比安慰剂产生更高的满意率，在氯米帕明50毫克剂量下，更高剂量导致更好的IELT，且不会导致更高的不良事件风险。吴P - C，洪C - S，康Y - N等。氯米帕明治疗早泄的耐受性和最佳治疗剂量：系统评价和荟萃分析。性医学2021；9：100283。
