PURPOSE: To compare the clinical efficacy and safety of three phosphodiesterase type 5 (PDE5) inhibitors in the treatment of mele erectile dysfunction according to patient preference. MATERIALS AND METHODS: Between January 2004 and August 2005, 113 male erectile dysfunctional patients were enrolled to this randomized, prospective, comparative, open-label, triple-crossover study of three PDE5 inhibitors. Patients were assigned to one of six medication schedules, and were prescribed a full dose of the drugs for 8 weeks, with a week of washout period prior to the next drug cycle. The International Index of Erectile Function (IIEF) scores and side effects related with each medication were obtained at the end of study. 48 patients finished all the medications, and completed the study with a global assessment questionnaire on their drug preference and reasons for that preference. RESULTS: The mean age of the patients was 54.6 (33-73) years. The mean pre-treatment IIEF and EF domain scores (+/-S.D.) were 28.2+/-14.7 and 10.6+/-6.6, respectively. The scores were significantly improved, to 47.9+/-14.6 and 19.9+/-6.6 with sildenafil, to 49.7+/-12.3 and 21.3+/-5.8 with vardenafil, and to 47.9+/-14.9 and 19.8+/-7.2 with tadalafil (p < 0.01). There were no significant differences in the scores or frequencies of side effects between the drugs. The preference percentages were 29.2, 29.2 and 35.4% for sildenafil, vardenafil and tadalafil, respectively. Patient preference was mainly due to improvement in erectile function (70.9%), such as rigid erection, prolonged erection and fast erection, and not to the infrequent rate of side effects (20.8%). CONCLISIONS: There were no significant differences of the efficacy and safety among the three PDE5 inhibitors. The preference for a drug for the treatment of erectile dysfunction was mainly related to the efficacy on the improvement of erectile function rather than the less frequent side effects.
Appointments and Schedules ; Erectile Dysfunction* ; Humans ; Male ; Patient Preference* ; Phosphodiesterase 5 Inhibitors* ; Phosphodiesterase Inhibitors ; Prospective Studies ; Questionnaires

In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
Andrology ; Erectile Dysfunction ; Korea ; Male ; Phosphodiesterase 5 Inhibitors

A multi-center, randomized, double-blind, placebo-controlled study was conducted with 158 subjects who were randomized to placebo or avanafil 50, 100, and 200 mg on demand for 8 weeks to evaluate the safety, tolerability, and efficacy of avanafil in the treatment of erectile dysfunction (ED) in Korean men. The primary outcome was the erectile function (EF) domain score of the International Index of Erectile Function (IIEF) questionnaire. Secondary outcomes included changes in the scores of IIEF questions 3 and 4 (IIEF Q3, Q4) from baseline, changes in all domain scores in the IIEF from baseline, Sexual Encounter Profile questions 2–5 (SEP2–5), the Global Efficacy Assessment Question (GEAQ), and the number of subjects whose EF domain score at the 8th week visit was ≥ 26. After 8 weeks of treatment, the dose groups except avanafil 50 mg scored significantly higher on the IIEF-EF domain from baseline than the placebo group. The changes from baseline in the avanafil group in IIEF Q3 (all doses) and Q4 (200 mg alone) were higher than the placebo group. The differences between avanafil and placebo groups were significant in SEP2 (100 and 200 mg) and SEP3–5 (200 mg). The differences in the GEAQ “Yes” response were also significant in the avanafil 100 and 200 mg groups. Regarding the ratio of normal EF at the end of the study, avanafil 200 mg differed significantly from the placebo. Most treatment-associated adverse events were mild and resolved spontaneously. This is a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT02477436).
Erectile Dysfunction* ; Humans ; Male ; Penile Erection ; Phosphodiesterase 5 Inhibitors

Inflammatory bowel disease is a recurrent chronic intestinal inflammatory disease with unknown etiology and no effective treatment. Phosphodiesterase (PDE) regulates a variety of physiological and pathophysiological processes by mediating the hydrolysis of intracellular second messengers cyclic adenosine monophosphate and cyclic guanosine monophosphate. In recent years, a series of researches suggest that PDE inhibitors such as several PDE4 inhibitors, PDE5 inhibitors (sildenafil, tadalafil and vardenafil), PDE3 inhibitors (cilostazol), PDE9 inhibitor (PF-04447943) and PDE3/PDE4 double inhibitor (pumafentrine) have ameliorating effect on experimental colitis in animals. In clinical trials, PDE4 inhibitor apremilast showed more therapeutic advantage than tetomilast. This article reviews the recent research progress of PDE inhibitors in treatment of inflammatory bowel disease.
Animals ; Colitis ; Inflammatory Bowel Diseases/drug therapy* ; Phosphodiesterase 4 Inhibitors

Phosphodiesterase type 5 (PDE5) inhibitors are used most commonly in the treatment of penile erectile dysfunction (ED). Recent studies show that PDE5 inhibitors are ideal drugs for treating ischemia-reperfusion injury. This review focuses on the results of basic and clinical researches on PDE5 inhibitors for the treatment of ischemia-reperfusion injury and provides some theoretical evidence for clinical options of the drugs.
Erectile Dysfunction ; drug therapy ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Phosphodiesterase Inhibitors ; therapeutic use ; Reperfusion Injury ; drug therapy

OBJECTIVETo observe and compare the effects and adverse events of the three phosphodiesterase type 5 (PDE-5) inhibitors sildenafil, vardenafil and tadalafil used in the same period for the treatment of erectile dysfunction (ED).

METHODSA total of 311 ED patients were treated with the three PDE-5 inhibitors in the same period, 134 with sildenafil, 109 with vardenafil and 88 with tadalafil, and followed up for 2-11 months. Their effects were compared.

RESULTSSildenafil produced satisfactory effect in 72 patients (79.12%), vardenafil in 63 (81.81%) and tadalafil in 52 (78.78%), respectively. And the efficacy rates of sildenafil, vardenafil and tadalafil in the treatment of ED with premature ejaculation were 55.56%, 44.44% and 42.3%, respectively. Our study also showed that the young and the newly married preferred vardenafil, the middle-aged chose tadalafil and the older and long-term users tend to take sildenafil. The main reasons for discontinuing the use of the three inhibitors were their high price, incomplete effect and the patients' worry about their adverse action.

CONCLUSIONThe three PDE-5 inhibitors can produce basically similar effects on ED, all with safety and few mild adverse events.

Adult ; Erectile Dysfunction ; drug therapy ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Phosphodiesterase 5 Inhibitors ; Phosphodiesterase Inhibitors ; administration & dosage

PURPOSE: To evaluate the preference factors for the treatment of erectile dysfunction (ED) with three different kinds of PDE-5 inhibitors. MATERIALS AND METHODS: This prospective, open-label study recruited 140 patients from 5 medical centers and urological clinics in the Daegu and Gyeongbuk area of South Korea. All patients underwent sildenafil, tadalafil, and vardenafil therapy with at least four attempts at sexual intercourse for each medication. There was a 1-week drug washout period following each medication period. Patients were asked to state their preference among the three medications. RESULTS: The mean age of the 140 patients was 50.9 years. Most patients had mild-to-moderate ED(57 patients, 40.7%) and moderate ED(47 patients, 33.6%), the remaining patients had mild(23 patients, 16.4%) or severe ED (13 patients, 9.3%). Of 140 evaluated patients, 58(41.3%) patients preferred treatment with tadalafil, compared with 39(28.1%) with sildenafil and 37(26.6%) with vardenafil. When grouped by age, tadalafil was most preferred by men in their 30s and 40s(42.9%, 57.5%), sildenafil was preferred by those in their 50s(48.3%), and vardenafil was preferred by those in their 60s(51.6%). The reasons for specific preferences were prolonged erectile function (68.0%) and good erectile function(66.0%) for tadalafil, good erectile function (88.2%) for the sildenafil, and good rigidity of the erect penis(59.4%) for vardenafil. CONCLUSIONS: Tadalafil was most preferred among the phosphodiesterase inhibitors, but the preference rates varied for men of different ages. All the medications were well tolerated.
Coitus ; Daegu ; Erectile Dysfunction ; Gyeongsangbuk-do ; Humans ; Korea ; Male ; Patient Preference ; Phosphodiesterase 5 Inhibitors* ; Phosphodiesterase Inhibitors ; Prospective Studies ; Sildenafil Citrate ; Tadalafil ; Vardenafil Dihydrochloride

PURPOSE: To evaluate the preference factors for the treatment of erectile dysfunction (ED) with three different kinds of PDE-5 inhibitors. MATERIALS AND METHODS: This prospective, open-label study recruited 140 patients from 5 medical centers and urological clinics in the Daegu and Gyeongbuk area of South Korea. All patients underwent sildenafil, tadalafil, and vardenafil therapy with at least four attempts at sexual intercourse for each medication. There was a 1-week drug washout period following each medication period. Patients were asked to state their preference among the three medications. RESULTS: The mean age of the 140 patients was 50.9 years. Most patients had mild-to-moderate ED(57 patients, 40.7%) and moderate ED(47 patients, 33.6%), the remaining patients had mild(23 patients, 16.4%) or severe ED (13 patients, 9.3%). Of 140 evaluated patients, 58(41.3%) patients preferred treatment with tadalafil, compared with 39(28.1%) with sildenafil and 37(26.6%) with vardenafil. When grouped by age, tadalafil was most preferred by men in their 30s and 40s(42.9%, 57.5%), sildenafil was preferred by those in their 50s(48.3%), and vardenafil was preferred by those in their 60s(51.6%). The reasons for specific preferences were prolonged erectile function (68.0%) and good erectile function(66.0%) for tadalafil, good erectile function (88.2%) for the sildenafil, and good rigidity of the erect penis(59.4%) for vardenafil. CONCLUSIONS: Tadalafil was most preferred among the phosphodiesterase inhibitors, but the preference rates varied for men of different ages. All the medications were well tolerated.
Coitus ; Daegu ; Erectile Dysfunction ; Gyeongsangbuk-do ; Humans ; Korea ; Male ; Patient Preference ; Phosphodiesterase 5 Inhibitors* ; Phosphodiesterase Inhibitors ; Prospective Studies ; Sildenafil Citrate ; Tadalafil ; Vardenafil Dihydrochloride

Erectile dysfunction (ED) is a common problem, for which PDE5 inhibitors (PDE5I) represent the first line therapy at present and have a success rate of approximately 80%. Refractory ED, which refers to ED in some patients with chronic diseases such as diabetes mellitus and cardiovascular diseases or in those treated by radical prostatectomy, receives little benefit from PDE5I alone. Apart from the NO-cGMP pathway, the processes of erection and ED involve several signaling pathways, such as RhoA/Rho kinase, H2S, CO, etc. The complicated signaling network contributes to the pathogenesis of refractory ED. PDE5I-based alternative therapy and combined therapy may increase the success rate of its treatment. This article outlines the advances in the studies of refractory ED that fails to respond to PDE5I.
Erectile Dysfunction ; drug therapy ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; therapeutic use

Phosphodiesterase-5 inhibitors (PDE5i) have been used as the first-line treatment for erectile dysfunction (ED) in recent years. However, with the increased clinical application of PDE5i, the incidence rate of PDE5i-induced adverse reactions is on the rise, which may involve the cardiovascular, digestive, nervous, respiratory, and reproductive systems. Most of the adverse reactions are mild to moderate, occasionally with serious or rare complications. The probability and severity of the adverse reactions are associated with the dosage and frequency of medication as well as with individual differences. Therefore individualized medication is necessitated and, for the patients with cardiovascular disease, epilepsy, psychosis, or anaphylactic conditions, PDE5i should be cautiously given or avoided. This review provides an overview of PDE5i-induced adverse reactions and countermeasures in the treatment of ED.
Erectile Dysfunction ; drug therapy ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; administration & dosage ; adverse effects