Achieving treatment optimization with sildenafil citrate (Viagra®) in patients with erectile dysfunction

McCullough, Andrew; Barada, James H.; Fawzy, Ahmed; Guay, André T.; Hatzichristou, Dimitrios

doi:10.1016/s0090-4295(02)01688-6

Cited by 170 publications

(153 citation statements)

References 18 publications

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“…20 Moreover, the tachyphylaxis effect from long-term use of sildenafil might need a dose escalation. 23,24 In the future, we might have to consider approval of the use of 100 mg sildenafil in Japan, too.…”

Section: Discussionmentioning

confidence: 99%

Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients

et al. 2005

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The approved maximal dose of sildenafil is only 50 mg in Japan, but the impact of dose regulation on treatment outcomes has not been established. Moreover, the contributors to the efficacy in patients having an intact peripheral nervous system have not been fully elucidated. We assessed in Japanese patients the treatment outcomes of sildenafil for erectile dysfunction (ED) under regulation of the approved dose and identified factors contributing to its efficacy among those with various etiologies other than pelvic surgery. We retrospectively reviewed 196 ED patients treated with sildenafil. The overall efficacy was 70.9% (139/196), and patients with psychological problems and concomitant cardiovascular disease showed high response rates (82.4 and 87.0%, respectively). Of the 139 responders, 89.9% achieved efficacy with a dose of 25 or 50 mg. Logistic regression analysis revealed concomitant cardiovascular disease and a favorable nocturnal penile tumescence result to be independent contributors to the efficacy.

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Section: Discussionmentioning

confidence: 99%

Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients

et al. 2005

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“…7 In clinical practice, it is very difficult to ask patients to try so many times before giving up, so less than four attempts was chosen as an inadequate attempt in this study. Rechallenge sildenafil failures B-P Jiann et al Sildenafil at doses higher than 100 mg has successfully salvaged previous nonresponders, but is limited by a significantly higher incidence of adverse effects and a high treatment discontinuation rate.…”

Section: Discussionmentioning

confidence: 99%

Rechallenge prior sildenafil nonresponders

Jiann

Cao

et al. 2004

Int J Impot Res

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To assess inappropriate use as a cause of sildenafil (Viagrat) failure and the feasibility of successfully rechallenging nonresponding patients, a total of 60 consecutive erectile dysfunction (ED) patients who first presented to our hospital and claimed poor response to sildenafil were enrolled into the study. The International Index of Erectile Function-5 (IIEF-5) was used to evaluate their baseline ED status and a self-administered sildenafil-use questionnaire composed of nine questions (SUQ-9) to assess how they had used sildenafil. A total of 44 subjects consent to rechallenge with sildenafil and were given thorough instruction based on individual answers to SUQ-9 and four doses of sildenafil 100 mg. After a 4-week follow-up, end point efficacy of rechallenge was evaluated using the IIEF-5 and the global assessment question (GAQ), 'After the treatment, did you have successful sexual intercourse?' Of the 60 subjects, 44 (77.3%) had one or more areas of major suboptimal use of sildenafil: 18 (30.0%) did not know that sexual stimulation was necessary for sildenafil to work, 36 (60.0%) attempted to use sildenafil less than four times, and 27 (45.0%) took a maximal dose less than 100 mg. Of the 44 patients undergoing sildenafil rechallenge, 34 (77.3%) completed the follow-up, while seven (15.9%) received only GAQ assessment by telephone interview and three (6.8%) were lost to follow-up. The total follow-up rate was 93.2% (41/44). Based on answers to the GAQ, the response rate to rechallenge was 58.5% (24/41). The mean improvement in the IIEF-5 score was 8.475.5 in responders (P o0.05). With individualized thorough instruction based on answers to SUQ-9 and scheduled follow-up, a high success rate was achieved by rechallenge with sildenafil in prior failures. The efficacy of sildenafil could be improved to a great extent by adequate education of patients and continuing medical education given to primary-care physicians.

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“…To date, there is to our knowledge no evidence from the literature that disease progression influences trial findings in erectile dysfunction, even though it is possible. Although there is some evidence for sildenafil in clinical settings that the full effect of the medication is reached only after multiple dosages, 1 we had no evidence from literature that in highest fixed dose trials the trial duration itself has a similar impact. It is also possible that phosphodiesterase 5 (PDE-5) inhibitor-naive patients (as in most sildenafil studies) may show higher response than men with PDE-5 inhibitor experience.…”

mentioning

confidence: 78%

Living in the best of all worlds. Despite premises approximating the truth with meta-analyses

Berner

Kriston

2006

Int J Impot Res

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Achieving treatment optimization with sildenafil citrate (Viagra®) in patients with erectile dysfunction

Cited by 170 publications

References 18 publications

Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients

Outcome analysis of sildenafil citrate for erectile dysfunction of Japanese patients

Rechallenge prior sildenafil nonresponders

Living in the best of all worlds. Despite premises approximating the truth with meta-analyses

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