PDE5i alone or in combination with SSRI better than SSRI monotherapy for premature ejaculation
It appears that use of phosphodiesterase type 5 inhibitors (PDE5i) alone or in combination with serotonin reuptake inhibitors (SSRIs) is more effective than SSRIs alone in patients with premature ejaculation (PE), according to the results of a network meta-analysis.
“Nevertheless, it also has a problem about the side effects of PDE5i including gastrointestinal or central nervous systems complications, which prevents it as the first-line treatment drug,” the authors noted.
Twenty-five studies met the eligibility criteria in this network meta-analysis. PE oral drugs involved in the studies primarily included SSRIs and PDE5i. Results showed that these oral drugs have varying efficacies for the treatment of PE.
In terms of intravaginal ejaculation latency time at 4–6 weeks, the cumulative rank probability from best to worst was as follows: SSRIs + PDE5i, PDE5i alone, and other SSRIs alone. This meta-analysis also revealed that fluoxetine 20 mg, dapoxetine 60 mg, PDE5i, and SSRIs + PDE5i had a higher incidence rate (IR) of clinically relevant complications. On the other hand, SSRIs alone had relative lower IR.
“Despite the development of some promising new therapeutic options, SSRIs remained as the first line of therapeutic PE oral drug through a synthetical consideration at present,” the authors said.
To compare the effectiveness of oral drugs and several relevant complications in patients with PE, the following databases were comprehensively searched up to 1 May 2018: PubMed, Embase and Web of Science. The safety and efficacy of oral drugs in PE were evaluated by using the pooled standard mean difference or odds ratios with 95 percent credible interval.