Meta-Analysis of the Long-Term Efficacy and Tolerance of Tadalafil Daily Compared With Tadalafil On-Demand in Treating Men With Erectile Dysfunction

Abstract

Background: Erectile dysfunction (ED) is highly prevalent in aging men. Tadalafil daily and on-demand are widely used for the treatment of ED.

Aim: We performed a meta-analysis to evaluate the efficacy and safety of tadalafil daily compared with tadalafil on-demand in treating men with ED after at least 24 weeks of long-term treatment.

Methods: Randomized controlled trials of tadalafil daily vs on-demand in treating men with ED were searched using MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The data was calculated by RevMan version 5.3.0. The references of related articles were also searched.

Outcomes: International Index of Erectile Function-Erectile Function domain, sexual encounter profile question 2 (SEP2), SEP question 3 (SEP3), any treatment-emergent adverse event (AE), discontinuation due to AEs, myalgia, back pain, headache, dyspepsia, and nasopharyngitis.

Results: 4 articles, including 1,035 participants were studied. The analysis found that tadalafil daily had a greater improvement than tadalafil on-demand in terms of International Index of Erectile Function-Erectile Function (mean difference (MD) 1.24; 95% CI 0.03-2.44; P = .04), SEP2 (MD 10.08; 95% CI 9.15-11.01; P < .00001) and SEP3 (MD 8.19; 95% CI 2.09-14.29; P = .009) in treating ED after at least 24 weeks treatment cycle. For safety, tadalafil on-demand had a higher incidence of any treatment-emergent AE (odds ratio 0.73; 95% CI 0.56-0.96; P = .02) compared with tadalafil daily, but for other aspects, including discontinuation due to AEs, myalgia, back pain, headache, dyspepsia, and nasopharyngitis, there were no significant difference between the 2 treatments.

Clinical implications: Tadalafil daily may offer a better effect for ED than on-demand for long-term treatment.

Strengths and limitations: From the perspective of evidence-based medicine, we evaluated the efficacy and safety of tadalafil daily compared with tadalafil on-demand in treating men with ED after a long-term treatment. The quality of these studies included is flawed, primarily in difference in tadalafil doses and severity of the ED.

Conclusion: Tadalafil daily provides a preferable therapeutic effect for ED with a lower incidence of treatment-emergent side effects relative to tadalafil on-demand after at least 24 weeks of long-term treatment. Zhou Z, Chen H, Wu J, et al. Meta-Analysis of the Long-Term Efficacy and Tolerance of Tadalafil Daily Compared With Tadalafil On-Demand in Treating Men With Erectile Dysfunction. J Sex Med 2019;7:282-291.

Keywords: Erectile Dysfunction; Long-Term Therapy; Meta-Analysis; Randomized Controlled Trials; Tadalafil.

Figure 1

Flowchart of the study selection process. ED, erectile dysfunction; RCT, randomized controlled trial.

Figure 2

Funnel plot of the studies included in our meta-analysis. OR, odds ratio; SE, standard error.

Figure 3

Forest plots showing change in (A) International Index of Erectile Function-Erectile Function domain, (B) Sexual Encounter Profile Question 2, and (C) Sexual Encounter Profile Question 3. df, degrees of freedom; IV, inverse variance.

Figure 4

Subgroup analysis of International Index of Erectile Function-Erectile Function (IIEF-EF) by the difference between the doses used for the treatments. df, degrees of freedom; IV, inverse variance.

Figure 5

Forest plots showing number with (A) any treatment-emergent adverse event and (B) discontinuation due to adverse events. df, degrees of freedom; M−H, Mantel−Haenszel.

Figure 6

Forest plots showing number with (A) myalgia, (B) back pain, and (C) headache. df, degrees of freedom; M−H, Mantel−Haenszel.

Figure 7

Forest plots showing number with (A) dyspepsia and (B) nasopharyngitis. df, degrees of freedom; M−H, Mantel−Haenszel.