ACP guideline: Oral therapy improves erectile function in men with ED

The American College of Physicians (ACP) has issued a new guideline that strongly recommends that physicians initiate therapy with an oral phosphodiesterase type-5 inhibitor in men who seek treatment for erectile dysfunction unless they have a contraindication to PDE-5 inhibitors, such as nitrate therapy.

The ACP recommends that physicians base the choice of a specific PDE-5 inhibitor on the individual preferences of patients, including ease of use, cost of medication, and adverse effects profile.

"The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials," said guideline lead author Amir Qaseem, MD, PhD.

Guideline authors analyzed evidence gathered from 130 randomized controlled trials that evaluated oral PDE-5 inhibitors alone or combined. Treatment with a PDE-5 inhibitor resulted in statistically significant and clinically relevant improvements in sexual intercourse and erectile function in patients with ED, regardless of the cause or baseline severity. The magnitude of benefit increased with severity of ED.

The therapy was well tolerated and associated with mild or moderate adverse effects.The guideline was published online in the Annals of Internal Medicine (Oct. 19, 2009).