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DC Field | Value | Language |
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dc.contributor.author | Mykoniatis, Ioannis | - |
dc.contributor.author | Pyrgidis, Nikolaos | - |
dc.contributor.author | Sokolakis, Ioannis | - |
dc.contributor.author | Ouranidis, Andreas | - |
dc.contributor.author | Sountoulides, Petros | - |
dc.contributor.author | Haidich, Anna-Bettina | - |
dc.contributor.author | VAN RENTERGHEM, Koenraad | - |
dc.contributor.author | Hatzichristodoulou, Georgios | - |
dc.contributor.author | Hatzichristou, Dimitrios | - |
dc.date.accessioned | 2021-04-06T13:12:49Z | - |
dc.date.available | 2021-04-06T13:12:49Z | - |
dc.date.issued | 2021 | - |
dc.date.submitted | 2021-03-09T12:17:30Z | - |
dc.identifier.citation | JAMA NETWORK OPEN, 4 (2) (Art N° e2036337) | - |
dc.identifier.issn | 2574-3805 | - |
dc.identifier.uri | http://hdl.handle.net/1942/33858 | - |
dc.description.abstract | IMPORTANCE Combining 2 first-line treatments for erectile dysfunction (ED) or initiating other modalities in addition to a first-line therapy may produce beneficial outcomes. OBJECTIVE To assess whether different ED combination therapies were associated with improved outcomes compared with first-line ED monotherapy in various subgroups of patients with ED. DATA SOURCES Studies were identified through a systematic search in MEDLINE, Cochrane Library, and Scopus from inception of these databases to October 10, 2020. STUDY SELECTION Randomized clinical trials or prospective interventional studies of the outcomes of combination therapy vs recommended monotherapy in men with ED were identified. Only comparative human studies, which evaluated the change from baseline of self-reported erectile function using validated questionnaires, that were published in any language were included. DATA EXTRACTION AND SYNTHESIS Data extraction and synthesis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES A meta-analysis was conducted that included randomized clinical trials that compared outcomes of combination therapy with phosphodiesterase type 5 (PDE5) inhibitors plus another agent vs PDE5 inhibitor monotherapy. Separate analyses were performed for the mean International Index of Erectile Function (IIEF) score change from baseline and the number of adverse events (AEs) by different treatment modalities and subgroups of patients. RESULTS A total of 44 studies included 3853 men with a mean (SD) age of 55.8 (11.9) years. Combination therapy compared with monotherapy was associated with a mean IIEF score improvement of 1.76 points (95% CI, 1.27-2.24; I-2 = 77%; 95% PI, -0.56 to 4.08). Adding daily tadalafil, low-intensity shockwave therapy, vacuum erectile device, folic acid, metformin hydrochloride, or angiotensin-converting enzyme inhibitors was associated with a significant IIEF score improvement, but each measure was based on only 1 study. Specifically, the weighted mean difference (WMD) in IIEF score was 1.70 (95% CI, 0.79-2.61) for the addition of daily tadalafil, 3.50 (95% CI, 0.22-6.78) for the addition of low-intensity shockwave therapy, 8.40 (95% CI, 4.90-11.90) for the addition of a vacuum erectile device, 3.46 (95% CI, 2.16-4.76) for the addition of folic acid, 4.90 (95% CI, 2.82-6.98) for the addition of metformin hydrochloride and 2.07 (95% CI, 1.37-2.77) for the addition of angiotensin-converting enzyme inhibitors. The addition of alpha-blockers to PDE5 inhibitors was not associated with improvement in IIEF score (WMD, 0.80; 95% CI, -0.06 to 1.65; I-2 = 72%). Compared with monotherapy, combination therapy was associated with improved IIEF score in patients with hypogonadism (WMD, 1.61; 95% CI, 0.99-2.23; I-2 = 0%), monotherapy-resistant ED (WMD, 4.38; 95% CI, 2.37-6.40; I-2 = 52%), or prostatectomy-induced ED (WMD, 5.47; 95% CI, 3.11-7.83; I-2 = 53%). The treatment-related AEs did not differ between combination therapy and monotherapy (odds ratio, 1.10; 95% CI, 0.66-1.85; I-2 = 78%). Despite multiple subgroup and sensitivity analyses, the levels of heterogeneity remained high. CONCLUSIONS AND RELEVANCE This study found that combination therapy of PDE5 inhibitors and antioxidants was associated with improved ED without increasing the AEs. Treatment with PDE5 inhibitors and daily tadalafil, shockwaves, or a vacuum device was associated with additional improvement, but this result was based on limited data. | - |
dc.description.sponsorship | This study was cofunded by the European Union and Greece through the Operational Programme Competitiveness, Entrepreneurship and Innovation under the Research-Create-Innovate project code T1EDK-00540. | - |
dc.language.iso | en | - |
dc.publisher | AMER MEDICAL ASSOC | - |
dc.rights | Open Access. This is an open access article distributed under the terms of the CC-BY License | - |
dc.subject.other | Adrenergic alpha-Antagonists | - |
dc.subject.other | Angiotensin-Converting Enzyme Inhibitors | - |
dc.subject.other | Antioxidants | - |
dc.subject.other | Combined Modality Therapy | - |
dc.subject.other | Drug Therapy, Combination | - |
dc.subject.other | Erectile Dysfunction | - |
dc.subject.other | Folic Acid | - |
dc.subject.other | Humans | - |
dc.subject.other | Hypoglycemic Agents | - |
dc.subject.other | Male | - |
dc.subject.other | Metformin | - |
dc.subject.other | Phosphodiesterase 5 Inhibitors | - |
dc.subject.other | Sildenafil Citrate | - |
dc.subject.other | Tadalafil | - |
dc.subject.other | Treatment Outcome | - |
dc.subject.other | Vitamin B Complex | - |
dc.subject.other | Equipment and Supplies | - |
dc.subject.other | Extracorporeal Shockwave Therapy | - |
dc.title | Assessment of Combination Therapies vs Monotherapy for Erectile Dysfunction A Systematic Review and Meta-analysis | - |
dc.type | Journal Contribution | - |
dc.identifier.issue | 2 | - |
dc.identifier.volume | 4 | - |
local.format.pages | 17 | - |
local.bibliographicCitation.jcat | A1 | - |
dc.description.notes | Mykoniatis, I (corresponding author), Aristotle Univ Thessaloniki, Sch Hlth Sci, Fac Med, Dept Urol, Ethnikis Aminis 41, Thessaloniki 54436, Greece. | - |
dc.description.notes | g_mikoniatis@hotmail.com | - |
dc.description.other | Mykoniatis, I (corresponding author), Aristotle Univ Thessaloniki, Sch Hlth Sci, Fac Med, Dept Urol, Ethnikis Aminis 41, Thessaloniki 54436, Greece. g_mikoniatis@hotmail.com | - |
local.publisher.place | 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA | - |
local.type.refereed | Refereed | - |
local.type.specified | Review | - |
local.bibliographicCitation.artnr | e2036337 | - |
dc.identifier.doi | 10.1001/jamanetworkopen.2020.36337 | - |
dc.identifier.pmid | 33599772 | - |
dc.identifier.isi | WOS:000619607900004 | - |
dc.contributor.orcid | SOKOLAKIS, IOANNIS/0000-0002-1938-8004 | - |
dc.identifier.eissn | 2574-3805 | - |
local.provider.type | wosris | - |
local.uhasselt.uhpub | yes | - |
local.description.affiliation | [Mykoniatis, Ioannis; Pyrgidis, Nikolaos; Sountoulides, Petros; Hatzichristou, Dimitrios] Aristotle Univ Thessaloniki, Sch Hlth Sci, Fac Med, Dept Urol, Ethnikis Aminis 41, Thessaloniki 54436, Greece. | - |
local.description.affiliation | [Pyrgidis, Nikolaos; Sokolakis, Ioannis; Hatzichristodoulou, Georgios] Martha Maria Hosp Nuremberg, Dept Urol, Nurnberg, Germany. | - |
local.description.affiliation | [Ouranidis, Andreas] Aristotle Univ Thessaloniki, Dept Pharmaceut Technol, Thessaloniki, Greece. | - |
local.description.affiliation | [Ouranidis, Andreas] Aristotle Univ Thessaloniki, Dept Chem Engn, Thessaloniki, Greece. | - |
local.description.affiliation | [Haidich, Anna-Bettina] Aristotle Univ Thessaloniki, Med Sch, Dept Hyg Social Prevent Med & Med Stat, Univ Campus, Thessaloniki, Greece. | - |
local.description.affiliation | [van Renterghem, Koenraad] Hasselt Univ, Jessa Hosp, Dept Urol, Hasselt, Belgium. | - |
local.description.affiliation | [van Renterghem, Koenraad] Univ Hosp Leuven, Dept Urol, Leuven, Belgium. | - |
local.uhasselt.international | yes | - |
item.validation | ecoom 2022 | - |
item.accessRights | Open Access | - |
item.fullcitation | Mykoniatis, Ioannis; Pyrgidis, Nikolaos; Sokolakis, Ioannis; Ouranidis, Andreas; Sountoulides, Petros; Haidich, Anna-Bettina; VAN RENTERGHEM, Koenraad; Hatzichristodoulou, Georgios & Hatzichristou, Dimitrios (2021) Assessment of Combination Therapies vs Monotherapy for Erectile Dysfunction A Systematic Review and Meta-analysis. In: JAMA NETWORK OPEN, 4 (2) (Art N° e2036337). | - |
item.fulltext | With Fulltext | - |
item.contributor | Mykoniatis, Ioannis | - |
item.contributor | Pyrgidis, Nikolaos | - |
item.contributor | Sokolakis, Ioannis | - |
item.contributor | Ouranidis, Andreas | - |
item.contributor | Sountoulides, Petros | - |
item.contributor | Haidich, Anna-Bettina | - |
item.contributor | VAN RENTERGHEM, Koenraad | - |
item.contributor | Hatzichristodoulou, Georgios | - |
item.contributor | Hatzichristou, Dimitrios | - |
crisitem.journal.issn | 2574-3805 | - |
crisitem.journal.eissn | 2574-3805 | - |
Appears in Collections: | Research publications |
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File | Description | Size | Format | |
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mykoniatis_2021_oi_201088_1612993978.85752 (1).pdf | Published version | 1.2 MB | Adobe PDF | View/Open |
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