Clinical efficacy of Apomorphine SL in erectile dysfunction of diabetic men

Abstract

Although subgroup analyses from large randomised premarketing studies have shown that Apomorphine SL enhances the percentage of erections firm enough for sexual intercourse in diabetic men, the clinical role of the drug in this patient population remains to be elucidated. The aim of the present study was to assess the efficacy of Apomorphine SL in diabetic males with erectile dysfunction (ED) and to identify factors predicting those who may benefit from the treatment. A total of 130 diabetic patients were randomised to receive either four tablets of 3 mg Apomorphine or a matching placebo. Assessments of efficacy comprised the erectile function (EF) domain of the International Index of Erectile Function (IIEF) and the one-item global efficacy question (GEQ). Patients with both a positive response to the GEQ and an improvement of at least 5 points in the EF domain of the IIEF were considered responders and subanalysed by several parameters indicative of the severity of both ED and diabetes. Response rate was 17% after placebo and 22% after Apomorphine SL. The EF domain of the IIEF and both questions 3 and 4 scores did not significantly improve in either of the two arms over the baseline. A younger age and a lower Hb1Ac were significantly linked to the status of responder in the Apomorphine arm. Apomorphine SL failed to show a statistically significant benefit over a placebo, but 22% of patients had a clinically significant erectile response. These figures seem to suggest that the drug has a limited use for ED diabetic patients.

Effect of prescription medications on erectile dysfunction

“…There is evidence that diabetes affects the central dopaminergic pathways, resulting in increased rates of ED and Parkinson’s disease 98. However, treatment with apomorphine, a D 1 /D 2 dopamine agonist, had an insignificant effect in the treatment of ED 99. Further studies are needed to assess the efficacy of dopamine agonists in treating diabetic ED.…”

Modulation of Dopaminergic Pathways to Treat Erectile Dysfunction

“…These findings suggest that affection of dopaminergic pathways in diabetes may also play a role in ED. However, the centrally acting dopaminergic agonist, apomorphine, induced only effect comparable to placebo in 130 patients with diabetes and ED, and the typical responder was young and with good glycaemic control . Further studies will be required to understand whether modulation of the dopaminergic pathways not only at central, but also at peripheral level may restore erectile function in diabetes.…”

Drug-Induced Impulse Control Disorders: A Prospectus for Neuroethical Analysis

“…persistent vegetative, minimally conscious states) [53] and traumatic brain injury [54], and erectile dysfunction [55]. DRT has also been suggested as a possible treatment of depression [56] and bipolar disorder [57].…”