Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)
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DOI：
10.1016/j.jsxm.2016.01.016
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发表时间：
2016-04-01
影响因子：
3.5
通讯作者：
Khera, Mohit
中科院分区：
文献类型：
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作者：
Hatzimouratidis, Konstantinos;Salonia, Andrea;Khera, Mohit
前言：勃起功能障碍的治疗大多以药物治疗为主。目的：从疗效、心理社会结局和安全性结果三个方面综述勃起功能障碍药物治疗的研究现状。所有相关文章都进行了批判性的分析和讨论。主要结果指标：在对文献和委员会共识进行深入分析的基础上，提供了证据水平(LES)和建议等级(GR)。(I)磷酸二酯酶5(PDE5)抑制剂是治疗男性勃起功能障碍(LE=1，GR=A)的有效、安全和耐受性良好的疗法。(Ii)不同的PDE5抑制剂在有效性、安全性和耐受性方面没有显著差异(LE=1，GR=A)。(Iii)PDE5抑制剂是大多数勃起功能障碍男性的一线治疗药物，这些男性对其使用没有特定的禁忌症(LE=3，GR=C)。(4)海绵体内注射前列地尔治疗男性勃起功能障碍(LE=1，GR=A)是一种有效且耐受性良好的治疗方法。(V)海绵体内注射前列地尔作为勃起功能障碍(LE=3，GR=C)的二线治疗。(Vi)对于男性勃起功能障碍(LE=1，GR=A)，尿路内注射和外用前列地尔是有效且耐受性良好的治疗方法。(Vii)对于勃起功能障碍，尿路内和局部应用前列地尔应被认为是二线治疗(LE=3，GR=C)。(Viii)强烈建议将PDE5抑制剂的剂量滴定到最大耐受量，因为它可以提高疗效和治疗满意度(LE=2，GR=A)。(9)治疗选择和后续行动应考虑到患者的心理社会状况以及对其性生活的需要和期望。强烈建议与患者(及其伴侣)共同决策(LE=2，GR=A)。(X)假药具有潜在危险性。强烈建议医生教育他们的患者避免服用任何未经授权的药物(LE=2，GR=A)。前7项建议与第三届国际性医学咨询的建议相同，后3项是新的建议。结论：PDE5抑制剂因其良好的疗效和安全性而仍是一线治疗选择。这类药物正在不断地开发新的分子和新的配方。海绵体内注射仍然是一种公认的治疗方式，而尿路内注射和局部应用前列地尔提供了一种侵入性较小的替代治疗方案。版权所有(C)2016，国际性医学学会。爱思唯尔公司出版，版权所有。
Introduction: Treatment of erectile dysfunction is based on pharmacotherapy for most patients.Aim: To review the current data on pharmacotherapy for erectile dysfunction based on efficacy, psychosocial outcomes, and safety outcomes.Methods: A review of the literature was undertaken by the committee members. All related articles were critically analyzed and discussed.Main Outcome Measures: Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus.Results: Ten recommendations are provided. (i) Phosphodiesterase type 5 (PDE5) inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction (LE = 1, GR = A). (ii) There are no significant differences in efficacy, safety, and tolerability among PDE5 inhibitors (LE = 1, GR = A). (iii) PDE5 inhibitors are first-line therapy for most men with erectile dysfunction who do not have a specific contraindication to their use (LE = 3, GR = C). (iv) Intracavernosal injection therapy with alprostadil is an effective and well-tolerated treatment for men with erectile dysfunction (LE = 1, GR = A). (v) Intracavernosal injection therapy with alprostadil should be offered to patients as second-line therapy for erectile dysfunction (LE = 3, GR = C). (vi) Intraurethral and topical alprostadil are effective and well-tolerated treatments for men with erectile dysfunction (LE = 1, GR = A). (vii) Intraurethral and topical alprostadil should be considered second-line therapy for erectile dysfunction if available (LE = 3, GR = C). (viii) Dose titration of PDE5 inhibitors to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment (LE = 2, GR = A). (ix) Treatment selection and follow-up should address the psychosocial profile and the needs and expectations of a patient for his sexual life. Shared decision making with the patient (and his partner) is strongly recommended (LE = 2, GR = A). (x) Counterfeit medicines are potentially dangerous. It is strongly recommended that physicians educate their patients to avoid taking any medication from unauthorized sources (LE = 2, GR = A). The first seven recommendations are the same as those from the Third International Consultation for Sexual Medicine and the last three are new recommendations.Conclusion: PDE5 inhibitors remain a first-line treatment option because of their excellent efficacy and safety profile. This class of drugs is continually developed with new molecules and new formulations. Intracavernosal injections continue to be an established treatment modality, and intraurethral and topical alprostadil provide an alternative, less invasive treatment option. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.