Levosulpiride for Premature Ejaculation: A Systematic Review and Meta-Analysis

Abstract

Premature ejaculation (PE) is one of the major causes of sexual dysfunction. Levosulpiride is an off-label medicine used to treat PE, but no review on its efficacy exists. A systematic review and meta-analysis was performed to determine the efficacy of levosulpiride in treating PE. Databases PubMed, Science Direct, and Google Scholar were searched. Randomized control trials (RCTs) comparing levosulpiride with placebo or other medicine were selected. Odds ratio (OR) of improved intravaginal ejaculation latency time (IELT) was calculated. A total of 97 articles were retrieved from database search, of which only four RCTs containing 203 men met the selection criteria. All four RCTs were included in systematic review while only two were included in meta-analysis. A high selection and detection bias was found in both of these studies. Meta-analysis also showed the odds of improving IELT in PE patients using levosulpiride to be significantly higher (p < .05) compared with those who used placebo, OR: 100.81, 95% confidence interval (CI) [13.12-774.90], I² = 0%. Odds of improving IELT for > 5 min (500% improvement) were also significantly higher (p < .05) compared with the placebo groups (OR: 38.88, 95% CI [5.12-295.29], I² = 0%). The odds of improving IELT for > 1 min, but < 5 min were also significantly higher (p < .05) than placebo groups (OR: 32.84, 95% CI [4.15-259.75], I² = 0%). Levosulpiride improved IELT, but even so, limited studies are available on this topic. Additional research is thus required to support the present review's findings.

Keywords: efficacy; levosulpiride; meta-analysis; premature ejaculation; sexual dysfunction.

Figure 1

Flowchart of Studies Selection

Figure 2.

Risk of Bias Graph: Review Authors’ Judgments About Each Risk of Bias Item Presented as Percentages Across All Included Studies

Figure 3

Risk of Bias Summary: Review Authors’ Judgments About Each Risk of Bias Item for Each Included Study

Figure 4

Forest Plot and Individual and Pooled Odds Ratios (95% CI) of Patients Who Improved IELT to That Poorly Improved/Not Improved (< 1 min) IELT When Treated With Placebo or Treatment Note. IELT = intravaginal ejaculation latency time.

Figure 5.

Forest Plot and Individual and Pooled Odds Ratios (95% CI) of Patients Who Improved IELT > 5 min to That Improved < 5 min IELT When Treated With Placebo or Treatment Note. IELT = intravaginal ejaculation latency time.

Figure 6.

Forest Plot and Individual and Pooled Odds Ratios (95% CI) of Patients Who Improved IELT > 1 min But < 5 min to That Poorly Improved/Not Improved (< 1 min) IELT When Treated with Placebo or Treatment Note. IELT = intravaginal ejaculation latency time.