title: First-generation phosphodiesterase type 5 inhibitors dropout: a comprehensive review and meta-analysis.
abstract: The discontinuation rate with phosphodiesterase type 5 inhibitors (PDE5i) remains very high. The aim of this study was to review and meta-analyze currently available data regarding dropout of the first-generation of PDE5i including sildenafil, vardenafil, and tadalafil. An extensive Medline Embase and Cochrane search was performed including the following words: 'PDE5i', 'discontinuation'. All observational studies reporting the dropout rate of PDE5i and its specific causes without any arbitrary restrictions were included. Out of 103 retrieved articles, 22 were included in the study. Retrieved trials included a total of 162,936 patients with a mean age of 58.8 ± 7.9 years. Prevalence of reported comorbid diabetes and hypertension were 27.7% and 36.9%, respectively. PDE5i were associated with a mean discontinuation rate of 4% per month (almost 50% after one year). This rate was higher in younger subjects and in those reporting a higher prevalence of associated morbidities. Six main reasons of PDE5i dropout were identified in the evaluated trials. Partner-related problems and lack of efficacy represented the most important reasons for PDE5i discontinuation, although no significant difference among factors was detected. In conclusion, despite their high efficacy and easy administration, the discontinuation rate and dissatisfaction with PDE5i are still very high. Our data showed that no single factor plays a major role in PDE5i dropout, suggesting that the discontinuation rate is usually because of a combination of both medical problems and psychosocial and relational factors.
authors.affiliation: Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Corona
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rastrelli
authors.affiliation: Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.|Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Burri
authors.affiliation: 'I Mulini' Medical Center, Cagliari, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Serra
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Gianfrilli
authors.affiliation: Diabetology, Careggi Teaching Hospital, Florence, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mannucci
authors.affiliation: Endocrinology, Andrology and Medical Sexology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.
authors.forename: E A
authors.initials: EA
authors.lastname: Jannini
authors.affiliation: Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Maggi
mesh_terms: D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D017060:Patient Satisfaction; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: dropout; erectile dysfunction; phosphodiesterase type 5 inhibitors