title: Toward a new 'EPOCH': optimising treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction.
abstract: Despite the marked adverse impacts of erectile dysfunction (ED) on quality of life and well-being, many patients (and/or their partners) do not seek medical attention for this problem, do not receive treatment or discontinue such treatment even when it has effectively restored erectile responses to sexual stimulation. Phosphodiesterase type 5 (PDE5) inhibitors are considered first-line therapies for men with ED. To help physicians maximise the likelihood of treatment success with these agents, we conducted an English-language PubMed search of articles involving approved PDE5 inhibitors dating from 1 January 1998 (the year in which sildenafil citrate was introduced), through 31 August 2008. In addition to sildenafil, tadalafil and vardenafil, search terms included 'adhere*', 'couple*', 'effect*', 'effic*', 'partner*', 'satisf*', 'succe*' and 'treatment outcome.' Based on our analysis, physician activities to promote favourable treatment outcomes may be captured under the mnemonic 'EPOCH': (i) Evaluating and educating patients and partners to ensure realistic expectations of therapy; (ii) Prescribing a treatment individualised to the couple's lifestyle needs and other preferences; (iii) Optimising treatment outcomes by scheduling follow-up visits with the patient to 'fine-tune' dosages and revisit key educational messages; (iv) Controlling comorbidities via lifestyle counselling, medications and/or referrals and (v) Helping patients and their partners to meet their health and psychosocial needs, potentially referring them to a specialist for other forms of therapy if they are not satisfied with PDE5 inhibitors.
authors.affiliation: State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sadovsky
authors.forename: G B
authors.initials: GB
authors.lastname: Brock
authors.forename: S W
authors.initials: SW
authors.lastname: Gutkin
authors.forename: S
authors.initials: S
authors.lastname: Sorsaburu
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control; D003865:Major Depressive Disorder / Q000150:complications; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D005194:Family Practice; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007989:Libido; D008019:Life Style; D008297:Male; D008487:Medical History Taking; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D010808:Physical Examination; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012747:Sexual Partners; D016896:Treatment Outcome
chemical_list: D010726:Phosphodiesterase Inhibitors