Association Between Phosphodiesterase-5 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy

Nathoo, Nawaaz; Etminan, Mahyar; Mikelberg, Frederick S.

doi:10.1097/wno.0000000000000186

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…11 In an analysis by Pomeranz 12 of data on adverse events from the FDA, reports of ischemic optic neuropathy associated with PDE5-I use were more numerous than the number of cases from the published literature. However, some previous articles also reported no significant association between NAION and PDE5-I use 13 , 14 and the causality between them could not be elucidated clearly in current publications. Therefore, we conducted a systematic review and meta-analysis to investigate their association through combined statistics to provide some further evidence for the occurrence of NAION and rational use of PDE5-Is.…”

Section: Introductionmentioning

confidence: 63%

“…A flowchart of the screening process of the meta-analysis is presented in Figure 1 . Of the 5 studies, 1 was a prospective case-crossover study, 19 1 was a retrospective case-crossover study, 12 1 was a retrospective case-control study, 13 and 2 were retrospective cohort studies. 14 , 20 The study by Flahavan et al 19 was conducted mostly in Caucasians in the United Kingdom, and the others were conducted in mixed populations.…”

Section: Resultsmentioning

confidence: 99%

“…For level-of-evidence assessment, the study by Flahavan el al 19 was rated level 2b and the others were rated level 3. 9 , 13 , 14 , 20 All 5 studies scored at least 7 stars and were regarded as high quality.

Figure 1 Flow diagram of meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

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The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

et al. 2018

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IntroductionPhosphodiesterase type 5 inhibitors (PDE5-Is) are first-line drugs for erectile dysfunction. Non-arteritic anterior ischemic optic neuropathy (NAION) has been linked with PDE5-I use. However, no meta-analysis or conclusive review has explored the association between NAION and PDE5-I use.AimTo investigate the association between PDE5-I use and risk of NAION.MethodsA comprehensive literature search was conducted using online databases in October 2017 to obtain studies researching the association between PDE5-I application and occurrence of NAION. Summarized unadjusted risk ratios (RRs) with 95% CIs were calculated for the strength of this association. This study was conducted in accordance to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and registered in PROSPERO under number CRD42017080865.Main Outcome MeasuresThe strength of association between PDE5-I use and risk of NAION was assessed through pooled unadjusted RRs and 95% CIs.Results5 original articles with 6 clinical observations were included in the meta-analysis. No significant higher risk of NAION was observed after the use of PDE5-Is within a 1-month period (RR = 1.16, 95% CI = 0.98-1.39, P = .09). Subgroup analyses indicated 2 PDE5-Is were significantly related to NAION (tadalafil: RR = 2.14, 95% CI = 1.20–3.84, P = .01; sildenafil: RR = 2.25, 95% CI = 1.29–3.94, P = .004).ConclusionsAlthough we found no association between NAION and PDE5-I use, our results should be interpreted cautiously because we included only observational studies and could not control for potential confounders. Because NAION is a rare ocular disease and difficult to diagnose, this association should be confirmed in prospective comparative studies with larger samples and more rigorous designs.Liu B, Zhu L, Zhong J, et al. The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. Sex Med 2018;6:185−192.

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Section: Introductionmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 99%

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The Association Between Phosphodiesterase Type 5 Inhibitor Use and Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis

et al. 2018

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“…Of note, anterior ischemic neuropathy has been reported in association with PDE-5 inhibitor (e.g., sildenafil, vardenafil, and tadalafil) use. Relative afferent pupillary defect, decreased color vision, and visual field defect indicate this type of neuropathy (9,10). Recently, Zahavi et al (11) demonstrated that sildenafil may induce ischemic retinal changes in a mouse model.…”

Section: Discussionmentioning

confidence: 99%

Ocular Side Effects of Sildenafil That Persist Beyond 24 h—A Case Series

Karaarslan

2020

Front. Neurol.

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“…In 2007, a large retrospective cohort study involving 4 157 357 male veterans found no increased risk of NAION in men prescribed PDE‐5 inhibitors [odds ratio 1.02 (95% confidence interval 0.92–1.12)] . Similar findings using administrative data have continued to accumulate, despite anecdotal reports of the close temporal relationships between drug exposure and vision loss . One pharmaceutical company conducted its own prospective study and found a twofold increased risk of NAION within five half‐lives of PDE‐5 inhibitor use, a hazard that translates to three additional cases of NAION per 100 000 men 50 years of age and older each year .…”

mentioning

confidence: 99%