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

[Speaker] Kannan Sridharan:1
[Co-author] Gowri Sivaramakrishnan:2, Reginald P Sequeira:1, Khalid Aj Khaja:1
1:Pharmacology and Therapeutics, Arabian Gulf University, Bahrain, 2:Fiji National University, Fiji

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. Consistency between the direct and indirect estimates were checked. Publication bias was assessed. Inverse variance heterogeneity model was used for mixed treatment comparisons. Intra-vaginal ejaculatory latency time (IELT) and adverse events were the main outcome measures. Odds ratio with 95% confidence intervals was the effect estimate. Grading of the evidence was carried out based on precision, consistency, directness, risk of bias and publication bias of the included studies.
A total of 48 studies were included in the meta-analysis. Dapoxetine 30 (1.2, 1-1.4) and 60 mg (1.7, 1.3-2.7), sildenafil (2.6, 1.3-3.9), paroxetine with sildenafil (3, 1.9-4.1), topical lidocaine (3.4, 2-4.7), vardenafil (3.5, 2-5), pindolol with paroxetine (4, 2.8-5.2), tramadol (4.5, 3.3-5.7), topical lidocaine with tadalafil (5.1, 4-6.2) and topical eutectic mixture of local anesthetic (6.4, 2.4-10.5) were associated with 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. Grading of the evidence ranged between very low to moderate and mild inconsistencies were observed between the direct and indirect pooled estimates.
Dapoxetine at 30 mg could be used as first-line agent in the management of PE.

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