Phosphodiesterase type 5 inhibitor therapy: identifying and exploring what attributes matter more to clinicians and patients in the management of erectile dysfunction

Background: Erectile dysfunction (ED) is increasingly being recognized as a sentinel marker of future subsequent cardiovascular disease (CVD). Predicted increases in the prevalence of ED are due to a combination of an aging population and the increasing presence of comorbid conditions (hypertension, dyslipidemia, and diabetes). The dichotomy of the situation is that ED is often associated with these comorbidities, potentially leading to greater CVD risk, and conversely, these comorbidities have also been shown to increase the risk of developing ED. The successful treatment of ED with phosphodiesterase type 5 (PDE5) inhibitor therapy, therefore, is of paramount importance because it not only plays a critical role in restoring erectile function, but also provides clinicians with the opportunity to mitigate existing cardiovascular comorbidities or prevent the occurrence of CVD in this patient population. Methods:This review is based on an electronic literature search of databases, including MEDLINE/PubMed, with information selected for its relevance to PDE5 inhibitor therapy comprising efficacy (e.g., first-dose success) in men with ED with or without comorbidities, onset and duration of action at specific time points, and patient preference. Results: The introduction of PDE5 inhibitors represented a major advance in the treatment of ED. In spite of the availability of these agents, a large percentage of men are still not being treated, in many cases because of their reluctance to seek medical help. Moreover, many men who start treatment with PDE5 inhibitors discontinue treatment. Reasons for discontinuation are many and complex, including lack of initial or first-time success. Although of major concern to both patients and clinicians, there remains limited published clinical data on this specific parameter in the pertinent patient population and from prospective, randomized clinical studies. Conclusion: Data from studies suggests that the available PDE5 inhibitor therapies are effective in treating men with ED, including those who have increased CVD risk and those who have clinically identified cardiovascular comorbidities such as hypertension, dyslipidemia, and/or diabetes. According to data from studies, the attributes of PDE5 inhibitor therapy that matter more to clinicians and patients and that hold influence over treatment compliance include effectiveness in patients with cardiovascular comorbidities, first dose effectiveness or early success, rapid onset of action, reliability, and tolerability.