Comparison between the efficacy and tolerability of On Demand Sildenafil citrate and Tadalafil in Treatment of Erectile Dysfunction in Type 2 Diabetic Patients

Abstract

Introduction: Data from head-to-head clinical trials of phosphodiesterase type 5 inhibitors are scarce, making it difficult for clinicians to select the most appropriate treatment for their patients with erectile dysfunction.
Aim: To compare efficacy and tolerability of Sildenafil and Tadalafil in men with erectile dysfunction and diabetes.

Method: A clinical, crossover and open label study was used.
A group of 95 patients were randomly recruited and answered an adapted questionnaire before and after usage of Sildenafil 100 mg and Tadalafil 20 mg to determine the improvement and compare efficacy and tolerability of each drug.
RESULTS: The one tailed Wilcoxon signed-rank test results for all the questions suggest that there is no statistically significant difference in response between Tadalafil and sildenafil p >0.05. However, for erection maintenance ability after penetration and for the overall response, the results suggest that there are statistically significant differences in response between Tadalafil and sildenafil p <0.05 in favor of Tadalafil.
Conclusion: Both drugs were highly effective and well tolerated in diabetic patients. Patient’s score on the erection scale with Tadalafil was superior than sildenafil in all questions. However, statistically significant differences were only detected in maintenance ability after penetration and the overall response. Probably, more significance could be detected if the sample size was larger.

References

1. Consensus N. Development Panel on Impotence. NIH Consensus Conference. Impotence. JAMA. 1993;270:83- 90.

2. Rosen RC, Wing R, Schneider S, Gendrano N. Epidemiology of erectile dysfunction: the role of medical comorbidities and lifestyle factors. Urologic Clinics. 2005;32(4):403-17.

3. Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes care. 2002;25(8):1458-63.

4. Cartledge J, Eardley I, Morrison J. Nitric oxide‐mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes. BJU international. 2001;87(4):402-7.

5. Denninger JW, Marletta MA. Guanylate cyclase and theâ‹… NO/cGMP signaling pathway. Biochimica et Biophysica Acta (BBA)-Bioenergetics. 1999;1411(2- 3):334-50.

6. Usta MF, Kendirci M, Gur S, Foxwell NA, Bivalacqua TJ, Cellek S, et al. The breakdown of preformed advanced glycation end products reverses erectile dysfunction in streptozotocin‐induced diabetic rats: Preventive versus curative treatment. The journal of sexual medicine. 2006;3(2):242-52.

7. Kolodny R, Masters W, Johnson V. Sexual anatomy and physiology. Textbook of Sexual Medicine Little, Brown and Co, Boston, MA. 1979:1-28.

8. Briganti A, Salonia A, Gallina A, Saccà A, Montorsi P, Rigatti P, et al. Drug insight: oral phosphodiesterase type 5 inhibitors for erectile dysfunction. Nature Reviews Urology. 2005;2(5):239.

9. Aversa A, Bruzziches R, Pili M, Spera G. Phosphodiesterase 5 inhibitors in the treatment of erectile dysfunction. Current pharmaceutical design. 2006;12(27):3467-84.

10. Schwarz E, Kapur V, Rodriguez J, Rastogi S, Rosanio S. The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems. International journal of impotence research. 2007;19(2):139.

11. Pomara G, Morelli G, Pomara S, Taddei S, Ghiadoni L, Dinelli N, et al. Cardiovascular parameter changes in patients with erectile dysfunction using PDE‐5 inhibitors: A study with sildenafil and vardenafil. Journal of andrology. 2004;25(4):625-9.

12. Huddleston AJ, Knoderer CA, Morris JL, Ebenroth ES. Sildenafil for the treatment of pulmonary hypertension in pediatric patients. Pediatric cardiology. 2009;30(7):871-82.

13. Bischoff E. Potency, selectivity, and consequences of nonselectivity of PDE inhibition. International journal of impotence research. 2004;16(S1):S11.

14. Montorsi F, Adaikan G, Becher E, Giuliano F, Khoury S, Lue TF, et al. Summary of the recommendations on sexual dysfunctions in men. The journal of sexual medicine. 2010;7(11):3572-88.

15. Rosen RC, Cappelleri J, Smith M, Lipsky J, Pena B. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.
International 1999;11(6):319. journal of impotence research.1999;11(6):319.

16. Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ: British Medical Journal. 2000;321(7259):499.

17. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-30.

18. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology. 1999;54(2):346-51.

19. Cappelleri JC, Siegel RL, Glasser DB, Osterloh IH, Rosen RC. Relationship between patient self-assessment of erectile dysfunction and the sexual health inventory for men. Clinical therapeutics. 2001;23(10):1707-19.

20. Rhoden E, Telöken C, Sogari P, Souto CV. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. International journal of impotence research. 2002;14(4):245.

21. Lue TF. Erectile dysfunction. New England Journal of Medicine. 2000;342(24):1802-13.

22. Angulo J, Cuevas P, Gabancho S, Allona A, Martı́n- Morales A, Moncada I, et al. Diabetes impairs endothelium-dependent relaxation of human penile vascular tissues mediated by NO and EDHF. Biochemical and biophysical research communications. 2003;312(4):1202-8.

23. Eardley I, Mirone V, Montorsi F, Ralph D, Kell P, Warner MR, et al. An open‐label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men naive to phosphodiesterase 5 inhibitor therapy. BJU international. 2005;96(9):1323-32.

24. Porst H. The 3 PDE 5 inhibitors sildenafil, tadalafil and vardenafil in patients with diabetes and ED-results of a comparative trial in 107 patients. The Journal of Sexual Medicine. 2005;2:21.

25. von Keitz A, Rajfer J, Segal S, Murphy A, Denne J, Costigan T, et al. A multicenter, randomized, double- blind, crossover study to evaluate patient preference between tadalafil and sildenafil. European urology. 2004;45(4):499-509.

Additional Files

Published

2018-06-26

How to Cite

Comparison between the efficacy and tolerability of On Demand Sildenafil citrate and Tadalafil in Treatment of Erectile Dysfunction in Type 2 Diabetic Patients. (2018). Lebda Medical Journal, 4(1), 148–153. Retrieved from https://lebmedj.elmergib.edu.ly/index.php/LMJ/article/view/74