Phosphodiesterase-5 (PDE5) Inhibitor Use In Middle Aged And Older Men With Erectile Dysfunction: Results From The Massachusetts Male Aging Study

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Urology / Nephrology
Article Date: 04 Nov 2006 - 0:00 PDT

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UroToday.com - In 1994, the first report from the Massachusetts Male Aging Study (MMAS) on the prevalence of erectile dysfunction (ED) identified that ED occurs in 52% of men between the ages of 40 and 70 (1).

At the time of approval in 1998 of the first phosphodiesterase Type 5 inhibitor (PDE5i) for the treatment of ED, most experts assumed that PDE5i's would be used extensively because ED is common and because these drugs are effective for about two-thirds of men with ED. A follow-up MMAS study reported at the 2006 meeting of the American Urological Association documents that PDE5i use in middle aged and older men with ED is far less than had been expected. In this recent MMAS follow-up study, PDE5i use was analyzed in 553 men with ED.

The age of the men at follow-up in 2002-2004 was 55-85 years. Despite the presence of ED and the availability and efficacy of PDE5i's, only 74 (13%) were taking PDE5i's. The reasons for low usage of PDE5i's are not clear.

The authors speculate that men may simply accept that ED is an inevitable consequence of aging or that they are reluctant to discuss ED with their physicians. Other experts have postulated other reasons for the low usage of PDE5i's such as ignorance of the efficacy of treatment, lack of a sexual partner and intercurrent illness. The underlying reason also must be at least partly related to decreased sexual interest, which may be much more common than previously suspected in men older than 55.

1. Feldman HA et al. Impotence and its medical and psychological correlates. Results of the Massachusetts Male Aging Study. J Urol 151:54-61, 1994.

Editor's Note:
The MMAS team has highlighted in detail what has been evident in the pharmaceutical marketplace since the introduction of multiple PDE-5 inhibitors: prescriptions are not consistent with the estimated prevalence of this disease, and rather that grow the market increased advertising for newer PDE-5 inhibitors has only succeeded in cutting up the pie. This same study group has also concluded that there is no statistical relationship between reported ED and recorded testosterone levels. So even if we exclude hypogonadism as a reason for non-treatment seeking behavior what explains the low use of such readily available therapies for ED? I believe there are many barriers to seeking treatment for ED: men don't readily seek out health care with an equal frequency as their age-matched females, ED is embarrassing and not a subject readily addressed by patients or physicians, ED is still perceived as a normal part of aging, and significant percentage of men with ED may have partners with female sexual dysfunction lowering expectations for the couple. Our message of encouragement to these potential patients has been that ED is not a lifestyle choice you have to live with. I believe current literature does demonstrate that ED is a risk factor for symptomatic coronary heart disease; this is most certainly the case for men with metabolic syndrome. Perhaps the correct message to men with ED should be: ED is not just a lifestyle choice, and failure to recognize and treat the comorbidities associated with ED means an increased risk of acute coronary disease. Whether these men ever request or accept a prescription for a PDE-5 inhibitor is not the point, getting evaluated cardiovascular disease is the point.

AUA 2006 - Abstract 1008: Araujo AB et al.

Reviewed by UroToday.com Contributing Editor Ira Sharlip, MD

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