Lu Youyi, Li Lin, Li Qi, Sun Guoqin
Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China.
Department of Cardiovascular, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong 264200, China.
J Sex Med. 2025 Jan 9;22(2):307-316. doi: 10.1093/jsxmed/qdae189.
Historically, β-blockers have been associated with erectile dysfunction (ED). Nebivolol, a third-generation β-blocker, may have had no negative effect on erectile function because of its vasodilating properties. However, the evidence level was considered either as low or very low.
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of nebivolol on erectile function.
All published RCTs were searched through PubMed, Cochrane Library, Web of Science, and Embase until October 2023. Review Manager version 5.3.0 was used for statistical analysis. Sensitivity analyses were performed by excluding each study using Stata 17 software.
The primary outcome was the International Index of Erectile Function (IIEF)-5 score. We excluded publication types, including letters, reviews, and meta-analyses.
We identified four RCTs in this meta-analysis. All included studies compared the effects of nebivolol vs metoprolol on erectile function. Eight parallel groups with 397 individuals reported IIEF-5 scores. A random-effect model revealed that the IIEF-5 score was significantly higher in the nebivolol group (MD 1.81, 95%CI 0.95-2.68, P < .0001, I2 = 99%). We conducted a sensitivity analysis by removing each individual study and observed that there was no significantly different result. Furthermore, we conducted a prespecified subgroup analysis based on the dosage of metoprolol, patients with ED at the time of enrollment, and disease type. Subgroup analysis revealed that heterogeneity significantly decreased, and the result of the IIEF-5 score was stable and consistent.
Our results provides stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression.
Our meta-analysis included high-quality RCTs and conducted a predetermined subgroup analysis. However, the main limitations are the limited number of included studies and their heterogeneity.
Our meta-analysis provided stronger evidence that nebivolol significantly reduced the risk of ED occurrence or progression compared with metoprolol, irrespective of whether the patient had ED or not. This meta-analysis could serve as an important reference for future studies in this field.
从历史上看，β受体阻滞剂与勃起功能障碍（ED）有关。奈必洛尔作为第三代β受体阻滞剂，因其血管舒张特性，可能对勃起功能没有负面影响。然而，证据水平被认为较低或非常低。
进行一项随机对照试验（RCT）的系统评价和荟萃分析，以确定奈必洛尔对勃起功能的影响。
通过PubMed、Cochrane图书馆、科学网和Embase检索截至2023年10月所有已发表的RCT。使用Review Manager 5.3.0版本进行统计分析。使用Stata 17软件通过排除每项研究进行敏感性分析。
主要结果是国际勃起功能指数（IIEF）-5评分。我们排除了包括信件、综述和荟萃分析在内的发表类型。
我们在这项荟萃分析中确定了四项RCT。所有纳入研究均比较了奈必洛尔与美托洛尔对勃起功能的影响。八个平行组的397名个体报告了IIEF-5评分。随机效应模型显示，奈必洛尔组的IIEF-5评分显著更高（MD 1.81，95%CI 0.95-2.68，P <.0001，I2 = 99%）。我们通过剔除每项个体研究进行了敏感性分析，观察到结果没有显著差异。此外，我们根据美托洛尔的剂量、入组时患有ED的患者以及疾病类型进行了预先设定的亚组分析。亚组分析显示异质性显著降低，IIEF-5评分的结果稳定且一致。
我们的结果提供了更强的证据，表明奈必洛尔显著降低了ED发生或进展的风险。
我们的荟萃分析纳入了高质量的RCT，并进行了预先设定的亚组分析。然而，主要局限性是纳入研究的数量有限及其异质性。
我们的荟萃分析提供了更强的证据，表明与美托洛尔相比，无论患者是否患有ED，奈必洛尔都显著降低了ED发生或进展的风险。这项荟萃分析可为该领域未来的研究提供重要参考。
