Docs decide the time is right to recommend an erectile dysfunction drug

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Just in case anyone out there was unconvinced that erectile dysfunction is best treated by popping one of those well-advertised pills, the American College of Physicians has officially proclaimed the superiority of drugs such as Viagra, Levitra and Cialis over hormone treatment.

Published in the Annals of Internal Medicine, the new clinical practice guideline finds that for most men who complain of erectile dysfunction, one of the phosphodiesterase Type-5 inhibitors -- sildenafil, tadalafil, and vardenafil -- is a more effective treatment than pills, creams, gels or patches containing testosterone.

The physicians group limited themselves to comparing ED drugs with testosterone therapy alone. They did not consider alternative treatments for erectile dysfunction that they said are rarely recommended by primary-care physicians, including psychotherapy, pump devices, suppositories or injections.

While oral or gel testosterone were a little more effective than a placebo in the studies reviewed by the guideline’s authors, the so-called PDE-5 inhibitors improved erections in 73%-88% of cases (compared with 26%-32% of cases in which a placebo improved the quality of a man’s erection). The practice guideline found little research evidence to recommend one of the five ED drugs over another, leading the authors to recommend that doctors base their prescribing decisions on a drug’s cost, ease of use, side effect profile and the patient’s preference.

The guideline’s drafters did find evidence that for sildenafil (Viagra) and vardenafil (Levitra), slightly higher doses (50 milligrams. and 20 milligrams, respectively) tended to yield the best results. (For tadalafil -- Cialis -- they found no dosage consistently superior).

Talking about the drugs’ side effects, the physicians who wrote the practice guideline complained that the research evidence in this area was ‘limited and inconclusive,’ and called for more to be done. They noted common side effects -- headache, flushing, stuffy nose and upset stomach -- but wrote that future trials need to flesh out which medications are most likely to result in the more serious side effects of visual disturbance, myalgia, nausea, diarrhea, vomiting and chest pain.

There’s plenty of money riding on this recommendation. Given the aging population, increased life expectancy and rising rates of diabetes and cardiovascular disease, the Annalsarticle cites a projection estimating that by 2025, 322 million men will suffer from ED. If all American men sought medical help for ED today, the cost could be $15 billion.

Which brings us to the question of whether the guideline’s authors are receiving money from the makers of ED drugs. Of the seven authors, one disclosed that he has received grants for research from Pfizer, maker of Viagra. A second author had received research funding from a variety of drug manufacturers, but none that produce ED drugs.

-- Melissa Healy