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Pharmacotherapy of premature ejaculation: a systematic review and network meta-analysis

  • Urology - Review
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Abstract

Purpose

The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for premature ejaculation (PE).

Methods

A systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for Systematic Reviews was performed on 1 March 2018. Intravaginal ejaculation latency time (IELT) was the main outcome. Analysis was performed under multivariate random-effects network model and efficacies of drugs were ranked with surface under the cumulative ranking (SUCRA) probabilities.

Results

A total of 48 studies were reviewed and 40 of them were further enrolled into network meta-analysis. The majority of RCTs were of unclear methodological quality. Pooled evidence suggested that topical anaesthetic creams (TAs), tramadol, selective serotonin reuptake inhibitors (SSRIs), and phosphodiesterase type 5 inhibitors (PDE5is) are more effective at prolonging IELT comparing with placebo. TAs (90%) on demand (OD) and PDE5is plus SSRI (89.8%) had the highest SUCRA, which meant the most probable to be the most effective intervention.

Conclusions

We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better designed clinical trials rather than it is more effective than the other drugs studied. TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs. PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects. PDE5is OD can be recommended to PE patients with ED.

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Funding

This article is supported by grants from 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZY2016104), Project of the Health and Family Planning Committee of Sichuan Province and The popularization and promotion of ureteroscopic technique in the treatment of upper urinary tract stones in primary hospitals (16PI294).

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  1. Zhongyu Jian, Xin Wei and Donghui Ye have contributed equally to this work.

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  1. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Zhongyu Jian, Xin Wei, Donghui Ye, Hong Li & Kunjie Wang

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  1. Zhongyu Jian
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ZJ and XW: project development, data collection and management, manuscript writing and revising, data analysis; DY: data collection, data analysis and revising; HL: data collection, data analysis; KW: project design and development, data interpretation, manuscript editing and revising. All authors read and approved the final manuscript.

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Correspondence to Kunjie Wang.

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Jian, Z., Wei, X., Ye, D. et al. Pharmacotherapy of premature ejaculation: a systematic review and network meta-analysis. Int Urol Nephrol 50, 1939–1948 (2018). https://doi.org/10.1007/s11255-018-1984-9

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