探讨局部药物治疗勃起功能障碍的进展范围综述。

Scoping review exploring advancements in topical agent therapies for erectile dysfunction.

机构信息

Department of Convergence Science, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, 22711, Republic of Korea.

Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.

出版信息

Sex Med Rev. 2024 Sep 25;12(4):731-738. doi: 10.1093/sxmrev/qeae056.

DOI:10.1093/sxmrev/qeae056

PMID:39128025

Abstract

INTRODUCTION

Erectile dysfunction (ED) is a common issue that affects older men and is often associated with various health conditions. Phosphodiesterase 5 inhibitors are commonly used to treat ED; however, their effectiveness may be limited, or the medication may be contraindicated. Therefore, topical gels are being developed as an alternative option for the pharmacologic treatment of ED.

OBJECTIVES

This review aimed to provide an overview of the efficacy and safety of topical agents for the treatment of ED.

METHODS

The PubMed, Cochrane, Embase, and Web of Science databases were searched. Articles were included that investigated ED and topical agents operating through the skin of the penis, evaluated the effectiveness of the treatment, and involved patients randomized into groups.

RESULTS

Topical alprostadil, glyceryl trinitrate (MED2005), and an over-the-counter formulation (MED3000) were used as alternative treatments for ED in 7 articles, which included 3475 patients. Topical alprostadil induced an erection in 67% to 75% of patients. Adequate erections for vaginal penetration were reported in 38.7% of the alprostadil-treated patients vs 6.9% of the placebo-treated patients. Topical alprostadil significantly and dose dependently improved the total score change on the International Index of Erectile Function as compared with the placebo. MED2005 exhibited a rapid onset of action, with nearly 70% effectiveness within 10 minutes. MED3000 met the minimal clinically important difference threshold of a 4-point increase on the erectile function domain of the International Index of Erectile Function, with an improvement of 5.73 points in 24 weeks. Topical therapy for ED also had acceptable safety profiles.

CONCLUSION

Topical agents via various mechanisms are effective and well-tolerated treatments for ED. A fast-acting drug that significantly reduces side effects as compared with other options has been discovered. However, its efficacy relative to current first-line therapies remains unclear. Topical agents present a viable therapeutic alternative for individuals who are unable or unwilling to take oral phosphodiesterase 5 inhibitors.

摘要

简介

勃起功能障碍（ED）是一种常见的问题，影响老年男性，常与各种健康状况有关。磷酸二酯酶 5 抑制剂常用于治疗 ED；然而，其疗效可能有限，或者药物可能禁忌。因此，正在开发局部凝胶作为 ED 药物治疗的替代选择。

目的

本综述旨在提供治疗 ED 的局部制剂的疗效和安全性概述。

方法

检索了 PubMed、Cochrane、Embase 和 Web of Science 数据库。纳入了调查 ED 和通过阴茎皮肤起作用的局部制剂的文章，评估了治疗效果，并纳入了随机分组的患者。

结果

在 7 篇文章中，局部前列腺素 E1（alprostadil）、甘油三硝酸酯（glyceryl trinitrate，MED2005）和一种非处方制剂（MED3000）被用作 ED 的替代治疗方法，共纳入 3475 例患者。局部前列腺素 E1 使 67%至 75%的患者产生勃起。接受 alprostadil 治疗的患者中有 38.7%报告有足够的阴道插入勃起，而接受安慰剂治疗的患者中仅有 6.9%。与安慰剂相比，局部前列腺素 E1 显著且剂量依赖性地改善了国际勃起功能指数的总评分变化。MED2005 起效迅速，在 10 分钟内有效率接近 70%。MED3000 在国际勃起功能指数的勃起功能域中达到了最小临床重要差异阈值 4 分的增加，24 周时改善了 5.73 分。ED 的局部治疗也具有可接受的安全性。