title: Phosphodiesterase 5 inhibitors for the treatment of erectile dysfunction: a trade-off network meta-analysis.
abstract: BACKGROUND
  Erectile dysfunction (ED) is a major health care problem worldwide and phosphodiesterase 5 inhibitors (PDE5Is) are the pharmacological treatment of choice. However, the optimal PDE5I for ED treatment is not known.
  
  
  OBJECTIVE
  To investigate trade-offs between efficacy and adverse events for various PDE5Is in treating ED.
  
  
  METHODS
  A review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Medline, Scopus, reference lists of relevant articles, and systematic reviews were searched. Eligible studies were randomized controlled trials comparing at least one PDE5I for treating ED with placebo or another PDE5I.
  
  
  RESULTS
  We included 82 trials (47 626 patients) for efficacy analysis and 72 trials (20 325 patients) for adverse event analysis. In the trade-off analysis of starting dosages, sildenafil 50mg had the greatest efficacy but also had the highest rate of overall adverse events. Tadalafil 10mg had intermediate efficacy but had the lowest overall rate of all adverse events. Vardenafil 10mg and avanafil 100mg had similar overall adverse events than sildenafil 50mg but a markedly lower global efficacy. Udenafil 100mg had similar global efficacy to that of tadalafil 10mg but its overall adverse event rates were higher.
  
  
  CONCLUSIONS
  This is the first trade-off analysis of the different PDE5Is currently available. For individuals who prioritize high efficacy, sildenafil 50mg appears to be the treatment of choice. Men wishing to optimize tolerability should take tadalafil 10mg or switch to udenafil 100mg in the case of insufficient efficacy.
  
  
  RESULTS
  For patients with erectile dysfunction who wish to prioritize high efficacy, sildenafil 50mg appears to be the treatment of choice. Men who wish to optimize tolerability should take tadalafil 10mg or switch to udenafil 100mg in the case of insufficient efficacy.
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Sergej E L
authors.initials: SE
authors.lastname: Staubli
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; Brain Research Institute, University of Zürich, Zürich, Switzerland; Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Alfons G
authors.initials: AG
authors.lastname: Kessels
authors.affiliation: Medignition Research Consultants, Zürich, Switzerland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ivic
authors.affiliation: Medignition Research Consultants, Zürich, Switzerland.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D054796:Drug Dosage Calculations; D057915:Drug Substitution; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000187:drug effects*; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: Erectile dysfunction; Network meta-analysis; Phosphodiesterase 5 inhibitors