A comparative, crossover study of the efficacy and safety of sildenafil and apomorphine in men with evidence of arteriogenic erectile dysfunction

Abstract

The aim of the study was to establish and compare the efficacy and safety of sildenafil and apomorphine in men with arteriogenic erectile dysfunction (ED). In all, 43 men with ED and postinjection max penile systolic velocity o25 cm/s in repeated Doppler ultrasonography were included. Of these, 24 men started on apomorphine 2 mg and 19 on sildenafil 50 mg, the doses titrated up to 3 and 100 mg according to effectiveness and tolerability. Safety was evaluated according to adverse events (AEs) and patient withdrawal. Efficacy was the percentage of attempts resulting in erections firm enough for intercourse, based on event log data. The incidence of AEs with apomorphine 3 mg was higher than with sildenafil 100 mg. Two men on apomorphine 3 mg discontinued treatment due to AEs. The overall success rate of sildenafil was 63.7% compared to 32.1% of apomorphine (Pearson v 2 , Po0.01). Of all men, 25 (58.1%) responded to sildenafil 50 mg without the need for dose increase, while only one responded to apomorphine 2 mg. The response to sildenafil 50 mg was age related (analysis of variance, p¼0.04). Satisfaction was reported by 76.75 and 13.95% of patients for sildenafil and apomorphine, respectively, but 20.9% were not satisfied with any of the two drugs. In conclusion, this study provides clear evidence that sildenafil, even at 50 mg dose, is more effective than apomorphine 3 mg in men with arteriogenic ED. The fact that one out of five patients is not satisfied with the above-studied drugs shows that new oral agents need to be evaluated for the treatment of this disorder.

Sildenafil combined with continuous positive airway pressure for treatment of erectile dysfunction in men with obstructive sleep apnea

“…The higher effectiveness of sildenafil may consequently explain the higher number of intercourse attempts reflecting the self-confidence strengthening of men for success. However, the effectiveness of sildenafil in the treatment of these patients seems to be constantly lower [18] than that reported in the general population of men similarly treated for ED [28,29], as well as in specific ED male populations [30,31]. It may be caused by the combination of smoking abuse and comorbidities, true risk factors for ED, and of the OSA-related hypoxia, which impairs NO's antioxidant function with adverse vascular consequences.…”

Erectile dysfunction in men with obstructive sleep apnea syndrome: a randomized study of the efficacy of sildenafil and continuous positive airway pressure

“…23 It seems probable that except for the high incidence of comorbidities that represent true risk factors for ED among the studied men, OSAS per se decreases 24 Moreover, one should take into account that in the sildenafil arm no CPAP was used for 3 months. Although the severity of OSAS in this group was mild (as suggested by the mean apnea/hypopnea indices), the persistency of the original OSAS symptoms may simply have negatively affected the overall quality of life in these patients, not allowing sildenafil to work better.…”

Vardenafil (Levitra) for erectile dysfunction: a systematic review and meta-analysis of clinical trial reports

“…Moreover, we need more data that will show the consistency of efficacy over time, since only two trials extend the duration of treatment over 12 weeks. While the direct comparison of the medications for the treatment of ED has started, 34 randomized trials should compare vardenafil with other treatment agents. With these data, the so-called 'phosphodiesterase inhibitor 'war' may come to an end.…”