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Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials

International Journal of Impotence Research volume 30, pages 215–223 (2018)Cite this article

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Abstract

Premature ejaculation (PE) is the most common sexual dysfunction in men. The present study is a network meta-analysis of drugs used for treating PE. Electronic databases were searched for randomized controlled trials comparing medical interventions with either placebo or with other active drugs in patients with PE. Inverse variance heterogeneity model was used for mixed-treatment comparisons. Intravaginal ejaculatory latency time (IELT) and adverse events were the main outcome measures. A total of 44 studies were included in the meta-analysis. Dapoxetine 30 and 60 mg, tadalafil, sildenafil, paroxetine with sildenafil, topical lidocaine, dapoxetine 30 mg with mirodenafil, vardenafil, fluoxetine, and tadalafil, pindolol with paroxetine, tramadol, topical lidocaine with tadalafil, paroxetine with tadalafil, and topical eutectic mixture of local anesthetics were associated with a significant increase in IELT. Similarly, dapoxetine 60 mg, venlafaxine, fluoxetine, tramadol at 25, 50, and 100 mg, and combined fluoxetine and tadalafil were associated with an increased risk of adverse events. Dapoxetine 30 mg has a high likelihood of being the “best” in the interventional pool. Dapoxetine at 30 mg could be used as the first-line agent in the management of PE.

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Acknowledgements

We thank PROSPERO for registering the review protocol. We are also grateful to Cochrane for utilizing RevMan 5.3 software for generating the risk of bias graph. We are grateful to EpiGear for using MetaXL in generating mixed-treatment comparison results for secondary outcomes and Erasmus Institute of Research Management for utilizing meta-essentials for assessing publication bias.

Author contributions

KS had full access to all of the data in the study. KS takes responsibility for the integrity of the data, the accuracy of the data analysis, and the final decision to submit for publication. Study concept and design: KS, GS, RG, and KA; acquisition, analysis, or interpretation of data: KS, GS, RG, and KA; drafting of the manuscript: KS, GS, RG, and KA; critical revision of the manuscript for important intellectual content: KS, GS, RG, and KA; and statistical analysis: KS and GS.

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  1. Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain

    Kannan Sridharan, Reginald P Sequeira & Khalid AJ Al-Khaja

  2. Department of Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji

    Gowri Sivaramakrishnan

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Sridharan, K., Sivaramakrishnan, G., Sequeira, R.P. et al. Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials. Int J Impot Res 30, 215–223 (2018). https://doi.org/10.1038/s41443-018-0030-x

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