PHARMACOLOGICAL MANAGEMENT OF PREMATURE EJACULATION:

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madman

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INTRODUCTION AND OBJECTIVE

Premature ejaculation(PE) is defined as concurrent brief ejaculatory time, loss of control, and related psychological distress to the patient and/or partner. While PE isone of the most prevalent male sexual dysfunctions, its management remains highly variable with a plethora of pharmacological options at the urologist’s disposal. Thus, we sought to comprehensively compare the efficacy of drugs and dosing regimens used in the treatment of PE.

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METHODS

In May 2023, a systematic review was performed to identify randomized controlled trials (RCTs) evaluating pharmacologic treatments in patients with PE. Included studies reported intravaginal ejaculatory latency time (IELT). Data was extracted independently by two authors and used to build a network model used to run 200,000 markov chain monte carlo iterations with samplings every 10 iterations in R. Studies were grouped by drug, dose and timing of the medication. The results are presented as mean difference (MD)with 95% credible intervals


RESULTS

We included 41 studies involving 9,025 patients that examined the effectiveness of pharmacological treatments for PE and reported IELT. Overall, the highest MD compared to placebo was with preintercourse dapoxetine 30 mg þmirodenafil 50 mg (MD 280.0 [23.0, 400.0]) and with the investigational drug named OLNP-05 (MD 280.0 [140.0,410.0]. Interestingly, lower doses of pre-intercourse tramadol (25 mgand 50 mg) also demonstrated a significant increase in IELT compared to a placebo, but this effect was not observed with higher doses (62 mgand 89 mg). Additionally, pre-intercourse lidocaine, either alone or in combination with prilocaine, led to significantly higher IELT compared to a placebo, with MD values of 240.0 [160.0, 310.0] and 260.0 [170.0,350.0], respectively. Furthermore, there was a general trend showing higher IELT in pre-intercourse medications compared to daily medications, when compared to a placebo. Results are shown in Figure 1.


CONCLUSIONS

In conclusion, our results show that preintercourse therapies appear to correlate with the highest MD in IELT compared to placebo. Knowledge from this study will aid the urologist in selecting pharmacological treatments most likely to benefit patients with PE.
 
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madman

Super Moderator
*Overall, the highest MD compared to placebo was with preintercourse dapoxetine 30 mg þmirodenafil 50 mg (MD 280.0 [23.0, 400.0]) and with the investigational drug named OLNP-05 (MD 280.0 [140.0,410.0]. Interestingly, lower doses of pre-intercourse tramadol (25 mgand 50 mg) also demonstrated a significant increase in IELT compared to a placebo, but this effect was not observed with higher doses (62 mgand 89 mg). Additionally, pre-intercourse lidocaine, either alone or in combination with prilocaine, led to significantly higher IELT compared to a placebo, with MD values of 240.0 [160.0, 310.0] and 260.0 [170.0,350.0], respectively. Furthermore, there was a general trend showing higher IELT in pre-intercourse medications compared to daily medications, when compared to a placebo
 
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