Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Minerva Urol Nephrol. 2024 Feb;76(1):42-51. doi: 10.23736/S2724-6051.23.05552-0.
Patients' treatment preferences (PTP) depend on the complex interaction of numerous patient- and treatment-related factors; their assessment can guide therapy and promote compliance of patients with erectile dysfunction (ED). We aimed to systematically describe the literature evaluating the treatment preferences of patients with ED, published in the last 25 years.
A comprehensive bibliographic search of multiple databases was conducted in June, 2023. The literature search was limited to the articles published since 1998. Articles were deemed eligible if they described male patients with ED (P) undergoing treatment for this condition (I) compared with other treatments, placebo or sham therapy (C), and reported PTP (O). Only randomized controlled trials (RCTs) and post-hoc analyses of RCTs were selected (S). The data were presented in a narrative fashion. The risk of bias (RoB) was evaluated using the RoB 2 tool and the Mulhall-Montorsi model.
A total 14 RCTs evaluating 6,841 patients and 4 post-hoc analyses of RCTs were included. All RCTs were considered to be at high RoB. No validated tool was used to investigate PTP. Sildenafil was the most frequently evaluated ED treatment (9 RCTs). Sildenafil was chosen over placebo by 78-100% of subjects and over ICI in 70% of patients due to its easier route of administration. No significant difference in patient preference was recorded between Sildenafil tablets and orodispersible (53% vs. 47%, P>0.05). Tadalafil was preferred over Sildenafil by 66-73% of patients (P<0.05), mainly because it allowed an erection long after taking the drug (55-67%). Tadalafil as-needed was chosen over Tadalafil 3 times/week by 57-59% of the patients (P<0.05).
The available RCTs support the preference of ED patients for Sildenafil over ICI, Tadalafil over Sildenafil, and Tadalafil as-needed over Tadalafil 3 times/week. However, these findings should be considered at high RoB.
患者的治疗偏好（PTP）取决于众多患者和治疗相关因素的复杂相互作用；评估这些偏好可以指导治疗，并提高勃起功能障碍（ED）患者的依从性。我们旨在系统描述过去 25 年评估 ED 患者治疗偏好的文献。
2023 年 6 月，我们对多个数据库进行了全面的文献检索。文献检索仅限于 1998 年以来发表的文章。如果文章描述了正在接受 ED 治疗的男性患者（P），并与其他治疗、安慰剂或假治疗（C）进行了比较，且报告了 PTP（O），则认为这些文章符合入选标准。仅选择了随机对照试验（RCT）和 RCT 的事后分析（S）。数据以叙述的方式呈现。使用 RoB 2 工具和 Mulhall-Montorsi 模型评估偏倚风险（RoB）。
共纳入了 14 项评估 6841 名患者的 RCT 和 4 项 RCT 的事后分析。所有 RCT 均被认为存在高 RoB。没有使用经过验证的工具来调查 PTP。西地那非是评估最多的 ED 治疗方法（9 项 RCT）。由于其给药途径更容易，78-100%的受试者选择西地那非而非安慰剂，70%的患者选择西地那非而非 ICI。西地那非片和口腔崩解片之间的患者偏好没有显著差异（53%比 47%，P>0.05）。66-73%的患者更喜欢他达拉非（P<0.05），主要是因为它可以在服用药物后很长时间保持勃起（55-67%）。57-59%的患者选择按需服用他达拉非而非每周 3 次服用他达拉非（P<0.05）。
现有的 RCT 支持 ED 患者对西地那非优于 ICI、他达拉非优于西地那非、按需服用他达拉非优于每周 3 次服用他达拉非的偏好。然而，这些发现应该在高 RoB 的情况下考虑。
