Comparison of Safety and Efficacy of Avanafil and Tadalafil in the Treatment of Erectile Dysfunction: A Prospective Observational Study

Background Erectile dysfunction (ED) is considered a condition commonly affecting men, particularly those over 40 years old, with a significant impact on quality of life. Phosphodiesterase-5 (PDE-5) inhibitors, including Avanafil and Tadalafil, are widely used for the treatment of ED. However, there is limited comparative data on their safety and efficacy. Objective This study aims to evaluate the safety and efficacy of Avanafil compared to Tadalafil when administered on-demand in patients with ED. Methods This prospective observational study was conducted over one year in a tertiary care hospital in India. A total of 106 patients with ED were enrolled and divided into two groups based on the medication prescribed by the treating physician: Group A received Avanafil (100 mg), and Group B received Tadalafil (10 mg). The key primary objective was to measure the change in the International Index of Erectile Function - Erectile Function (IIEF-EF) domain scores at 4, 8, and 12 weeks. Secondary outcomes included changes in other IIEF domains, Sexual Encounter Profile (SEP) scores, and partner satisfaction. Adverse events were recorded to assess safety. Results Both Avanafil and Tadalafil significantly improved IIEF-EF scores from baseline. Tadalafil showed superior efficacy, with statistically significant improvements in IIEF-EF scores at 4 weeks (p = 0.008), 8 weeks (p < 0.01), and 12 weeks (p < 0.01) compared to Avanafil. There were no significant differences between the two groups in terms of orgasmic function, sexual desire, intercourse satisfaction, or overall satisfaction. SEP profiles were similar between the groups throughout the study. Adverse effects were mild and comparable between the groups, with no significant differences in the overall incidence of side effects. Conclusion Tadalafil demonstrated slightly better efficacy in improving erectile function compared to Avanafil, although both drugs were effective and well-tolerated. The choice of treatment should consider patient preferences and specific clinical contexts, as both medications offer significant benefits with minimal risk of severe adverse effects. Both PDE-5 inhibitors were effective based on patient-reported outcomes, although objective rigidity was not measured.