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

Abstract

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.

Risk of nonarteritic ischaemic optic neuropathy with phosphodiesterase type 5 inhibitors: a systematic review and meta‐analysis

“…The association between the use of PDE 5 inhibitors and the development of NAION is not yet established (Koksal et al 2005;Huang & Lie 2013;Shamloul & Ghanem 2013;Liu et al 2018). Several physiopathological hypotheses were studied.…”

“…This led to a rapid systemic hypotension, one of the risk factors of NAION (Koksal et al 2005;Liu et al 2018). Phosphodiesterase type 5 inhibitors may also have a role in the perfusion of optic nerve head, causing a local deregulation (Koksal et al 2005;Liu et al 2018). PDE 6 enzyme is present in ocular blood vessels and has an important function in phototransduction.…”

“…One systematic review also performed a meta-analysis with observational studies (Liu et al 2018). An association between PDE 5 inhibitors use and the development of NAION was also not found (Liu et al 2018).…”

“…One systematic review also performed a meta-analysis with observational studies (Liu et al 2018). An association between PDE 5 inhibitors use and the development of NAION was also not found (Liu et al 2018). This review only included observational studies, excluding other type of observational data, such as case and series of case reports and spontaneous reports.…”

Pathogenese und Therapie der nicht arteriitischen anterioren ischämischen Optikusneuropathie

“…Risikofaktor Einnahme von Phosphodiesterase-5-Hemmern (z. B. Sildenafil) [16] gebiet, die, vor allem basierend auf Erkenntnissen aus der Schlaganfallforschung, kontrovers diskutiert wird [26,27]. Molekularpathologisch wird der "Point of no return", ab dem, nach heutigem Wissensstand, der Zelltod in den betroffenen Ganglienzellen unumkehrbar eintreten wird, durch den Zusammenbruch der mitochondrialen Atmungskette markiert.…”