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Erectile dysfunction in patients with diabetes mellitus — advances in treatment with phosphodiesterase type 5 inhibitors

Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA, Kenneth.Snow{at}joslin.harvard.edu

Erectile dysfunction (ED) is a common complication of diabetes mellitus. In four independent, 12-week, randomised, placebo-controlled clinical trials that evaluated the pro-erectile properties of the selective phosphodiesterase type 5 (PDE-5) inhibitors, sildenafil (Viagra) (25—100 mg), tadalafil (10 and 20 mg) and vardenafil (10 and 20 mg) in men with ED secondary to diabetes mellitus, all the active drugs were significantly superior to placebo. In this difficult-to-treat population, the greatest difference from placebo for the overall responder rate of diabetic men reporting improved erections occurred with vardenafil 20 mg (72% vs. 13% for placebo).

All the PDE-5 inhibitors were generally well tolerated. There were fewer reports of visual disturbance with vardenafil or tadalafil than with sildenafil, which may be due to their greater selectivity for PDE-5 inhibition and less cross-reactivity with retinal PDE-6 inhibition.

The studies suggest there may be significant differences between the three drugs. However, only head-to-head studies will determine true differences in both efficacy and side effect profile.

Key Words: diabetes • erectile dysfunction • PDE-5 inhibitors • sildenafil • tadalafil • vardenafil.

References

• Hakim LS, Goldstein I. Diabetic sexual dysfunction. Endocrinol Metab Clin North Am 1996;25:379-400.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Feldman HA, Goldstein I., Hatzichristou DG et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61.[Web of Science][Medline] [Order article via Infotrieve]
• Martin-Morales A., Sanchez-Cruz JJ, Saenz de Tejada I. et al. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol 2001; 166:569-74; discussion 574-5.
• Sairam K., Kulinskaya E., Boustead GB et al. Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction. BJU Int 2001;88:68-71.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• NIH. National Institute of Health Consensus Development Panel on Impotence. JAMA 1993;270:83-90.[Abstract/Free Full Text]
• De Berardis G., Franciosi M., Belfiglio M. et al. Erectile dysfunction and quality of life in type 2 diabetic patients. Diabetes Care 2002;25:284-91.[Abstract/Free Full Text]
• Eardley I. Pathophysiology of erectile dysfunction. Br J Diabetes Vasc Dis 2002;2:272-6.[Abstract/Free Full Text]
• Lue TF Erectile dysfunction. New Engl J Med 2000;342:1802-13.[Free Full Text]
• Saenz de Tejada I., Goldstein I., Azadzoi K. et al. Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. New Engl J Med 1989;320:1025-30.[Abstract]
• Krane RJ, Goldstein I., Saenz de Tejada I. Impotence. New Engl J Med 1989;321:1648.[Web of Science][Medline] [Order article via Infotrieve]
• Korenman SG New insights into erectile dysfunction: a practical approach. Am J Med 1998;105:135.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hackett G. Schedule 11 - impact on treating erectile dysfunction. Br J Diabetes Vasc Dis 2002;2:315-18.[Abstract/Free Full Text]
• Hatzichristou DG, Pescatori ES Current treatments and emerging therapeutic approaches in male erectile dysfunction. BJU International 2001;88:11-7.[CrossRef]
• Lipshultz LI, Kim ED Treatment of erectile dysfunction in men with diabetes. JAMA 1999;281:465-6.[Free Full Text]
• Vinik A., Richardson D. Erectile dysfunction in diabetes. Diabetes Reviews 1998;6:16-33.[Web of Science]
• Fedele D., Bortolotti A., Coscelli C. et al. Erectile dysfunction in type 1 and type 2 diabetics in Italy. Int J Epidemiol 2000;29:524-31.[Abstract/Free Full Text]
• Klein R., Klein BEK, Lee KE et al. Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996;19:135-41.[Abstract]
• Romeo JR, Seftel AD, Madhum Z. et al. Sexual function in men with diabetes type 2: Association with glycemic control. J Urol 2000;163:788-91.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Klotz T., Sachse R., Heidrich A. et al. Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: A RigiScan and pharmacokinetic study. World J Urol 2001;19:32-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rosen RC, Riley A., Wagner G. et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822-30.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rosen R., Bennet A., Ferguson D. et al. Standards for clinical trials in erectile dysfunction: Research designs and outcomes assessment. In Jardin A, Wagner G, Khoury S, Guiliano F, Padma-Nathan H and Rosen C. Erectile Dysfunction. Health Publications 2000.
• Angulo J., Gadau M., Fernandez A. et al. IC351 enhances NO-mediated relaxation of human arterial and trabecular penile smooth muscle. Eur Urol 2001;39:106, abstract 415.
• Saenz de Tejada I., Angulo J., Cuevas P. et al. The phosphodiesterase inhibitory selectivity and in vivo potency of the new PDE-5 inhibitor vardenafil. Int J Impot Res 2001;13:282-90.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Goldstein I., Young JM, Fischer J. et al. Vardenafil, a new highly selective PDE-5 inhibitor, improves erectile function in patients with diabetes mellitus. Diabetes 2001;50(suppl 2):114.
• Goldstein I. and Investigators of the Vardenafil Diabetes Phase III Study. Vardenafil demonstrates improved erectile dysfunction in diabetic men with erectile dysfunction. Int J Impot Res 2001;13:(suppl 5):S65, abstract 24.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rendell MS, Rajfer J., Wicker PA et al. Sildenafil for treatment of erectile dysfunction in men with diabetes. JAMA 1999;281:421-6.[Abstract/Free Full Text]
• Boulton AJM, Selam J-L., Sweeney M. et al. Sildenafil for the treatment of erectile dysfunction in men with type II diabetes mellitus. Diabetologia 2001;44:1296-301.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Saenz de Tejada I., Emmick J., Anglin G. et al. The effect of IC351 taken as needed for treatment of erectile dysfunction in men with diabetes. Eur Urol 2001;39:16, abstract 56.
• Rendell M., Goldstein I., Collins O. et al. Vardenafil significantly improved erectile function and quality of life in men with diabetes and erectile dysfunction. Poster presented at the 2nd World Congress of the Aging Male, Berlin 2002.
• Porst H., Rosen R., Padma-Nathan H. et al. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor in patients with erectile dysfunction: the first at-home clinical trial. Int J Impotence Res 2001;13:192-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hatzichristou DG Sildenafil citrate: lessons learned from 3 years of clinical experience. Int J Impotence Res 2002;14:S43-S51.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Padma-Nathan H., McMurray JG, Pullman WE et al. On-demand IC351 (CialisTM) enhances erectile function in patients with erectile dysfunction. Int J Impotence Res 2001;13:2-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Milligan PA, Marshall SF, Karlsson MO A population pharmacokinetic analysis of sildenafil citrate in patients with erectile dysfunction. Br J Clin Pharmacol 2002;53:45S-52S.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Patterson BE, Bedding AW, Jewell H. et al. Dose-normalised pharmacokinetics of tadalafil administered as a single dose to healthy volunteers. Eur Urol 2002;1(suppl 1):152, abstract 600.
• Berkrot B. Setback for Lilly's Viagra rival gives edge to Bayer AG. Reuters Company News, May 1st 2002. http://biz.yahoo.com/rc/020501/health_bayer_impotence_8.html

The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 4, 282-287 (2002)
DOI: 10.1177/14746514020020040901


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Snow, K. J Search for Related Content Social Bookmarking                         What's this?