To evaluate the efficacy and safety of oral phosphodiesterase-5 inhibitors (PDE5Is) in the treatment of erectile dysfunction (ED). Additionally, to compare various PDE5Is and assess their suitability for different patient populations. A systematic review of literature published from January 1999 to January 2023 was conducted following the PICOS criteria. We analyzed meta-analyses, randomized controlled trials, and prospective studies focusing on PDE5Is. Only studies evaluating drugs used in France (namely sildenafil, tadalafil, vardenafil, and avanafil ) were analyzed. The outcomes measured included the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and adverse event profiles. Publications addressing specific comorbidities, such as prostate cancer-related ED or lower urinary tract symptoms, were excluded. Out of 87 studies were reviewed, all four drugs have similar efficacy and toxicity profiles. Sildenafil, vardenafil and avanafil have similar pharmacokinetic profiles, whereas tadalafil has a different one enabling a daily usage. Adverse events were generally mild, including headache, myalgia, backache, dyspepsia, nasopharyngitis and flushing, with the highest tolerability observed in low-dose tadalafil. No significant differences in efficacy were observed between daily and on-demand tadalafil. PDE5Is are effective first-line treatments for ED, with similar efficacy and safety profiles. The choice of PDE5I should be tailored to the patient's needs, comorbidities, and lifestyle preferences. Future studies should address specific subpopulations to optimize clinical practice guidelines.
Ala et al. (Mon,) studied this question.
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