Compliance of sildenafil treatment for erectile dysfunction and factors affecting it

Abstract

To assess the compliance of treatment, its affecting factors, and reasons for dropout, a questionnaire was mailed to a cohort of 2139 subjects who received sildenafil prescriptions for erectile dysfunction (ED) at our institution from 1999 to 2002. A total of 726 subjects (34%) with a mean age of 67 years answered the questionnaires. The response rate for sildenafil treatment was 67%. Of these sildenafil responders, 43% reported that they continued using sildenafil while 57% did not, in a mean follow-up of 3 years. Common reasons for discontinuation were effect below expectations, high cost, loss of interest in sex, and inconvenience in obtaining sildenafil. The continuers showed a higher rate than the discontinuers (P < 0.05) of having tried other treatments, dose titration, and a dose higher than 50 mg. The discontinuers reported having a lower mean responding dose and improvement score post sildenafil treatment than the continuers. In conclusion, effect below expectations was the leading reason for discontinuation of sildenafil treatment. How ED subjects tried the medication and the adequacy of education in the initial treatment period may impact the compliance of sildenafil treatment.

PDE5 Inhibitor Treatment Persistence and Adherence in Brazilian Men: Post-hoc Analyses from a 6-Month, Prospective, Observational Study

“…The rates of persistence and adherence observed here are difficult to compare directly to some previous reports due to use of chart reviews, differences in follow-up times, or other methodological differences (9,11,17). Nonetheless, the findings are consistent with a persistence rate of 69% (per at least one prescription refill) through 6 months found in patients who began successful therapy with sildenafil (12), and perhaps with discontinuation rates of 47.6% and 45.4% among men previously treated and men naive to ED therapy, respectively, after a mean of 17-18 months follow-up (18), although higher persistence was reported at 6 and 12 months with tadalafil in one study (90% and 84%, respectively) (10).…”

“…Among non-persistent patients, commonly cited reasons for discontinuing PDE5I therapy have included the cost of medication, loss of interest in sex, loss of a sexual partner, lack of efficacy, or improvements in ED (10)(11)(12). Notably, a lack of efficacy may be due to either the drug or to improper use of the medication.…”

Assessing satisfaction in men and their female partners after treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction

“…10 In a series of 101 men who had been prescribed products for home intracavernosal injections, but had not used them, 51% attributed their nonuse to their partners' refusal to co-operate with this treatment. 30 In another study, 19/73 (23%) patients who abandoned sildenafil treatment attributed this to a failure of their partner to show any sexual interest during the study period.…”

“…Treatment satisfaction was defined as an EDITS Index or EDITS Partner Index score X50, and treatment dissatisfaction as an Index score o50. The severity of ED was based on the total SHIM score, with 22-25 representing no ED, 17-21 representing mild ED, 12-16 representing mild to moderate ED, [8][9][10][11] representing moderate ED and o7 representing severe ED. 22 …”

“…[7][8][9] In spite of these reported improvements, there is a high dropout rate among PDE5 inhibitor responders, which ranges from 57 to 31%. 10,11 Although the reasons for the high dropout rate are diverse, female partners of men with ED are thought to have a key supportive role in the successful long-term treatment of ED. 12 Including the female partner in consultations may highlight discordant attitudes and communication problems between couples.…”