An open-label, multicenter, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in Chinese men naïve to phosphodiesterase 5 inhibitor therapy Phosphodiesterase inhibitors in the treatment of erectile dysfunction in spinal cord-injured men A randomized clinical trial investigating treatment choice in Chinese men receiving sildenafil citrate and tadalafil for treating erectile dysfunction A multicenter, randomized, double-blind, crossover study of patient preference for tadalafil 20 mg or sildenafil citrate 50 mg during initiation of treatment for erectile dysfunction. Adherence to initial PDE-5 inhibitor treatment: randomized open-label study comparing tadalafil once a day, tadalafil on demand, and sildenafil on demand in patients with erectile dysfunction. An analysis of treatment preferences and sexual quality of life outcomes in female partners of Chinese men with erectile dysfunction A 6-month, prospective, observational study of PDE5 inhibitor treatment persistence and adherence in Middle Eastern and North African men with erectile dysfunction A return to normal erectile function with tadalafil once daily after an incomplete response to as-needed PDE5 inhibitor therapy. Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: results of a European multicenter, open-label study of patient preference. Efficacy and safety of tadalafil 20 mg on demand vs. tadalafil 5 mg once-a-day in the treatment of post-radiotherapy erectile dysfunction in prostate cancer men: a randomized phase II trial. A randomized open-label trial with a crossover comparison of sexual self-confidence and other treatment outcomes following tadalafil once a day vs. tadalafil or sildenafil on-demand in men with erectile dysfunction. Treatment preferences in men with erectile dysfunction: an open label study in Korean men switching from sildenafil citrate to tadalafil. Efficacy and safety of on-demand oral tadalafil in the treatment of men with erectile dysfunction in Taiwan: a randomized, double-blind, parallel, placebo-controlled clinical study. Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report. An evaluation of an alternative dosing regimen with tadalafil, 3 times/week, for men with erectile dysfunction: SURE study in 14 European countries. Psychosocial outcomes after initial treatment of erectile dysfunction with tadalafil once daily, tadalafil on demand or sildenafil citrate on demand: results from a randomized, open-label study Combination therapy with selective serotonin reuptake inhibitors and phosphodiesterase‐5 inhibitors in the treatment of premature ejaculation
The study was to compare treatment preference , efficacy , and tolerability of sildenafil citrate ( sildenafil ) and tadalafil for treating erectile dysfunction ( ED ) in Chinese men naοve to phosphodiesterase 5 ( PDE5 ) inhibitor therapies .  This multicenter , r and omized , open-label , crossover study evaluated whether Chinese men with ED preferred 20-mg tadalafil or 100-mg sildenafil . After a 4 weeks baseline assessment , 383 eligible patients were r and omized to sequential 20-mg tadalafil per 100-mg sildenafil or vice versa for 8 weeks respectively and then chose which treatment they preferred to take during the 8 weeks extension . Primary efficacy was measured by Question 1 of the PDE5 Inhibitor Treatment Preference Question naire ( PITPQ ) . Secondary efficacy was analyzed by PITPQ Question 2 , the International Index of Erectile Function ( IIEF ) erectile function ( EF ) domain , sexual encounter profile ( SEP ) Questions 2 and 3 , and the Drug Attributes Question naire . Three hundred and fifty men ( 91 % ) completed the r and omized treatment phase . Two hundred and forty-two per 350 ( 69.1 % ) patients preferred 20-mg tadalafil , and 108/350 ( 30.9 % ) preferred 100-mg sildenafil ( P < 0.001 ) as their treatment in the 8 weeks extension . Ninety-two per 242 ( 38 % ) patients strongly preferred tadalafil and 37/108 ( 34.3 % ) strongly the preferred sildenafil . The SEP2 ( penetration ) , SEP3 ( successful intercourse ) , and IIEF-EF domain scores were improved in both tadalafil and sildenafil treatment groups . For patients who preferred tadalafil , getting an erection long after taking the medication was the most reported reason for tadalafil preference . The only treatment-emergent adverse event reported by > 2 % of men was headache . After tadalafil and sildenafil treatments , more Chinese men with ED naοve to PDE5 inhibitor preferred tadalafil . Both sildenafil and tadalafil treatments were effective and safe Study design : Open , before – after study . Objective : To assess the efficacy and safety of phosphodiesterase type 5 ( PDE5 ) inhibitors for erectile dysfunction ( ED ) in spinal cord-injured ( SCI ) patients . Setting : Home- and clinic-based assessment s in the outpatient department at the Centre Bouffard Vercelli , Cerbère France . Methods : Clinic trials with Sildenafil ( Viagra ® )  on 120 patients , Tadalafil ( Cialis ® ) on 54 patients and Vardenafil ( Levitra ® ) on 66 patients were performed . Flexible doses of PDE5 inhibitors were given depending on efficacy and tolerability , from 50 to 100 mg for Sildenafil , and from 10 to 20 mg for Vardenafil and Tadalafil . Each trial was performed after a week 's interval . The efficacy was self-assessed by the patients on a six-point quantitative scale assessment . The response to treatment was assessed at home in 90 patients ( 57 patients on Sildenafil , 12 patients on Vardenafil and 21 patients on Tadalafil )  using the International Index of Erectile Function ( IIEF ) . Results : In clinic trials , PDE5 inhibitors were effective ( rigidity enough for penetration ) in 85 % of the patients on Sildenafil , 74 % of the patients on Vardenafil and 72 % of the patients on Tadalafil .  The mean duration of erection was 34 , 28 and 26 min , respectively . Adverse effects were mild , usually attenuated with continued dosing . More than 70 % of the patients on Vardenafil and Tadalafil required higher doses of 20 mg , whereas 50 mg of Sildenafil was effective in 55 % of the patients . Two-thirds of our patients on Tadalafil reported a duration of action longer than 24 h. The presence of an upper motor neuron lesion was significantly associated with therapeutic success , lower motor neuron lesions and cauda equina patients were poor responders . Other variables such as completeness of lesion had no impact . In the follow-up visits , the IIEF global scores and three IIEF domains ( erectile function , intercourse satisfaction and overall satisfaction ) were significantly improved in all patients . Patients on Sildenafil showed a significant improvement of orgasmic function , ejaculation ( Question 9 ) and orgasm ( Question 10 ) . Conclusion : Sildenafil , Vardenafil and Tadalafil are all effective and well-tolerated treatments for ED in SCI patients . Although no statistical analysis could be applied on these data , these results might indicate that Sildenafil is more effective in treating ED . Clinic trials are important for proper dose titration and appropriate education of the patients Sildenafil and tadalafil are efficacious and well tolerated in Chinese men with erectile dysfunction ( ED ) . Recent study results indicate that men with ED in China who were naïve to phosphodiesterase inhibitor type 5 ( PDE5 ) therapy prefer tadalafil 20-mg ( on-dem and ) versus sildenafil 100-mg ( on-dem and ) . Differences in psychosocial outcomes may help to explain treatment preference in favor of tadalafil . This open-label , r and omized , crossover study compared psychosocial outcomes and drug attribute choices between tadalafil and sildenafil in Chinese men with ED naïve to PDE5 inhibitor therapy . Eligible patients were r and omized to sequential 20-mg tadalafil/100-mg sildenafil ( n = 190 ) or 100-mg sildenafil/20-mg tadalafil ( n = 193 ) for 8 weeks each and were asked which treatment they preferred to take for the 8-week extension phase . Psychosocial outcomes were assessed using the Psychological and Interpersonal Relationship Scale ( PAIRS ) , Drug Attributes Question naire ( DRAQ ) , and Sexual Life Quality Question naire ( SLQQ ) . When taking tadalafil versus sildenafil , men had a higher mean endpoint score on the PAIRS Spontaneity Domain  ( tadalafil = 2.86 vs sildenafil = 2.72 ; P < 0.001 ) , and a lower mean endpoint score on the Time Concerns Domain ( tadalafil = 2.41 vs sildenafil = 2.55 ; P < 0.001 ) . A numerical increase in the Sexual Self-Confidence Domain was observed when taking tadalafil versus sildenafil ( tadalafil = 2.76 vs sildenafil = 2.72 ; P = 0.102 ) . The most frequently chosen drug attributes explaining treatment preference were able to get an erection long after having drug , and ability to get an erection every time . SLQQ results were comparable between treatment groups . These psychosocial outcomes may explain why more Chinese men preferred tadalafil versus sildenafil for the treatment of ED in this clinical trial BACKGROUND Tadalafil is a phosphodiesterase 5 ( PDE5 ) inhibitor approved in > 30 countries for the treatment of erectile dysfunction ( ED ) . It has been shown to improve erectile function compared with placebo in Phase III studies , but clinical experience comparing tadalafil with the PDE5 inhibitor sildenafil citrate is lacking . OBJECTIVE This study compared patient preference for tadalafil 20 mg or sildenafil 50 mg during initial treatment for ED . It also compared the tolerability of the 2 agents at these doses . METHODS This r and omized , double-blind , fixed-dose , 2-period crossover trial took place at 13 sites in the United States and Germany . Patients were r and omized 1:1 to receive 4 weeks of treatment with tadalafil 20 mg or sildenafil 50 mg , followed by the alternative treatment , to be taken as needed up to once daily before sexual activity . RESULTS The study enrolled 215 men with ED , 109 r and omized to the tadalafil-sildenafil sequence and 106 to the sildenafil-tadalafil sequence . Their mean age was 49.8 years ; 84.7 % were sildenafil naive and 15.3 % had undergone a previous inadequate trial of sildenafil . Most patients had moderate ED ( 60.5 % ) of > or=1 year 's duration ( 74.9 % ) . Of 190 evaluable patients , 126 ( 66.3 % ) preferred to initiate treatment with tadalafil , compared with 64 ( 33.7 % ) with sildenafil ( P < 0.001 ) . Patients ' preference did not differ by age , duration of ED , treatment sequence , or previous sildenafil exposure . Both medications were well tolerated , with no significant differences in the incidence of treatment-emergent adverse events . Headache ( 11.2 % tadalafil , 8.8 % sildenafil ) , dyspepsia ( 6.0 % and 4.2 % , respectively ) , nasopharyngitis ( 4.7 % and 2.8 % ) , and flushing ( 2.8 % and 4.7 % ) were the most common adverse events . The rate of ocular disturbances was low : 1 patient experienced intermittent bilateral reduction in visual acuity with tadalafil , and 2 exhibited conjunctival hyperemia or eyelid edema with sildenafil . CONCLUSIONS Tadalafil 20 mg was preferred to sildenafil 50 mg for the initiation of ED therapy in this study population . Both medications were well tolerated INTRODUCTION Phosphodiesterase type 5 ( PDE-5 ) inhibitor treatment for erectile dysfunction ( ED ) is frequently discontinued ; adherence may vary depending on the initial regimen . AIM To evaluate the effects of initiating treatment with tadalafil once a day ( OaD ) , tadalafil on dem and ( pro re nata [ PRN ] ) , or sildenafil PRN on treatment adherence . METHODS In this multicenter , open-label study , men ( ≥ 18 years ) with ED , naïve to PDE-5 inhibitors , were r and omized ( 1:1:1 ) to tadalafil 5 mg OaD , tadalafil 10 mg PRN , or sildenafil 50 mg PRN . An 8-week r and omized treatment ( RT ) period ( dose adjustment possible ) was succeeded by 16 weeks of pragmatic treatment ( switches between PDE-5 inhibitors allowed ) . MAIN OUTCOME MEASURES Treatment adherence was measured as time to discontinuation of RT ( any cause ) , estimated by Kaplan-Meier product-limit method . Treatment-group differences were estimated as hazard ratio ( HR ; Cox proportional hazards ) . RESULTS Seven hundred seventy patients ( mean age 53 years ) were r and omized to tadalafil OaD ( N = 257 ) , tadalafil PRN ( N = 252 ) , and sildenafil PRN ( N = 261 ) . Kaplan-Meier estimates for patients discontinuing RT were 52.2 , 42.0 , and 66.7 % , respectively . Median time to discontinuation of RT was significantly longer for tadalafil OaD and PRN ( 130 and > 168 days ) compared with sildenafil ( 67 days ) ( HR [ 97.5 % confidence interval ] : 0.66 [ 0.51 , 0.85 ] and 0.49 [ 0.37 , 0.65 ] ; P < 0.001 ) . Reasons for discontinuation with significant differences between groups ( P < 0.05 ) included " lack of efficacy ( duration of erection ) " ( sildenafil 9.2 % vs. tadalafil OaD 4.3 % , PRN 2.8 % ) , " time constraints due to short window of action "  ( sildenafil 4.2 % vs. tadalafil OaD 0 % , PRN 0.4 % ) , and " feel medication controls my sexual life "  ( sildenafil 2.7 % vs. tadalafil OaD 0 % ) . No between-group differences were found in International Index of Erectile Function-Erectile Function domain change from baseline to end of RT ( least squares mean : 9.4 - 10.0 , P = 0.359 ) or discontinuations due to adverse events ( 1.2 - 1.6 % ) . The most common adverse event ( ≥ 4 % ) was headache . CONCLUSIONS ED patients assigned to tadalafil OaD or PRN adhered significantly longer to initial treatment than patients assigned to sildenafil PRN . Improvement of erectile function and safety profiles were similar in all three treatment groups The impact of erectile dysfunction is distressing to both males and their female partners , but less attention has been paid to identify female partners′ preferred treatment and sexual quality of life outcomes . The present analysis explores female partners′ treatment preference for erectile dysfunction in Chinese Men . This was a phase 4 , r and omized , open-label , multicenter , crossover study in Chinese men with erectile dysfunction who were naïve to phosphodiesterase type 5 inhibitor treatments . Eligible patients were r and omized to sequential 20-mg tadalafil/100-mg sildenafil or 100-mg sildenafil/20-mg tadalafil for 8 weeks each . Of 418 patients , female partners of 64 patients agreed to enter the study ; of 64 patients who entered the study with female partners , 63 were r and omized , and 62 completed the study . Baseline demographics and disease characteristics were comparable between treatment groups . Significantly more couples preferred tadalafil compared with sildenafil overall ( 75.4 % vs 24.6 % ; P < 0.001 ) , and irrespective of erectile dysfunction severity at baseline ( P ≤ 0.005 ) . Significant improvements in sexual quality of life scores were reported at endpoint ( Visit 8) in male patients and female partners in both tadalafil and sildenafil treatment groups ( P < 0.001 ) . Significantly higher mean changes from baseline were observed for male patients in the tadalafil group compared with the sildenafil group for the erectile function ( P = 0.013 ) and overall satisfaction ( P = 0.019 ) International Index for Erectile Function domains and the spontaneity domain ( P < 0.001 ) of the Psychological and Interpersonal Relationship Scale . No major safety concerns were reported during the study . Though both treatments were effective , safe , and tolerable , more couples preferred tadalafil compared with sildenafil Abstract Background : Erectile dysfunction ( ED ) negatively impacts quality of life .  Phosphodiesterase type 5 inhibitors ( PDE5Is ) are effective in treating ED ; however , rates of discontinuation remain high . Objectives : To assess on-dem and PDE5I treatment persistence and adherence through 6 months in Middle Eastern and North African ( MENA ) men with ED in a prospect i ve , non-interventional , observational trial . Research design and methods : Enrolled men were ≥18 years old from Saudi Arabia , Egypt , and the United Arab Emirates , PDE5I naïve , and sexually active .  PDE5Is were selected per routine clinical practice . Persistence was defined as use of ≥1 dose during the prior 4 weeks , adherence as compliance with dosing instructions during the most recent dose . Logistic regression models were used to identify factors associated with persistence and adherence . Main outcome measures : Persistence and Adherence Question naire ; Partner Relationship Question naire ; Self-Esteem and Relationship Question naire ; International Index of Erectile Function ( IIEF ) ; Erectile Dysfunction Inventory of Treatment Satisfaction . Results : Patients ’ ( n = 493 ) mean age was 49.8 years , mean BMI was 29.3 , and the majority ( n = 354 , 71.8 % ) were from Saudi Arabia .  Tadalafil was the most prescribed PDE5I ( 69.6 % ) , versus sildenafil ( 15.4 % ) , or vardenafil ( 15.0 % ) . Patients ’ mean IIEF – Erectile Function scores improved from moderate to mild and Erection Hardness Scores ( SD ) improved from 1.8 ( 1.0 ) at baseline to 3.5 ( 0.7 ) at 6 months . At 6 months , 64.9 % of patients were treatment persistent ( tadalafil , 68.8 % , sildenafil , 65.8 % , and vardenafil , 45.9 % ) and 59.6 % were adherent . Factors significantly predictive ( p < 0.05 ) of persistence at 6 months included age , employment status , and ED severity . Factors significantly predictive of adherence were age , employment status , and duration of ED . Interpretation of differences between drugs was limited by substantial differences in prescription rates between countries . Conclusions : At 6 months , 64.9 % of men were treatment persistent . In this study , age , employment status , ED severity , and duration of ED were associated with persistence and /or adherence INTRODUCTION An optimal outcome of an erectile dysfunction ( ED ) treatment is to enable a return to normal erectile function ( as defined by an International Index of Erectile Function-Erectile Function [ IIEF-EF ] domain score ≥ 26 ) . As-needed ( PRN ) phosphodiesterase type 5 ( PDE5 ) inhibitor treatment does not always result in a return-to-normal erectile function . AIM The combined studies evaluated whether treatment with tadalafil once daily would allow men to return to normal erectile function who had less than normal IIEF-EF domain scores while using a maximum dose of a PRN PDE5 inhibitor treatment . METHODS Men were ≥ 18 years of age , sexually active , reported a ≥ 3-month history of ED , and had been taking the maximum dose of sildenafil citrate , vardenafil , or tadalafil PRN . R and omization to once-daily therapy with tadalafil 2.5 mg to 5 mg ( N = 207 ) , tadalafil 5 mg ( N = 207 ) , or placebo  ( N = 209 ) for 12 weeks followed a 4-week maximum dose PRN PDE5 treatment and 4-week nondrug lead periods . Two identical double-blind , r and omized , placebo-controlled studies were conducted ; combined results are reported . MAIN OUTCOME MEASURE The main outcome measure was the percentage of subjects with a return-to-normal erectile function ( IIEF-EF domain score ≥ 26 ) when treated with tadalafil once daily compared with placebo . RESULTS In subjects not achieving normal erectile function with the maximum dose of a PRN PDE5 inhibitor , a higher percentage of subjects treated with tadalafil  had an IIEF-EF domain score ≥ 26 at end point ( tadalafil 2.5- to 5-mg group [ 39 % ] ; tadalafil 5-mg group [ 40 % ] ) compared with the placebo group ( 12.1 % ; P < 0.001 ) . Tadalafil was generally well tolerated and adverse events observed were consistent with previous reports of tadalafil once daily . CONCLUSIONS Treatment with tadalafil once daily significantly improved erectile function in men with mild to mild-moderate impairments in erectile function following PRN PDE5 inhibitor treatment BACKGROUND Three inhibitors of phosphodiesterase 5 ( PDE5 ) are now available for the treatment of erectile dysfunction ( ED ) : sildenafil citrate , vardenafil , and tadalafil . Pharmacologic differences between these compounds may result in patient preferences for one over another and may influence treatment decisions made by the physician and patient . Therefore , clinical research is needed to investigate whether individual properties of the PDE5 inhibitors play a role in shaping patient preference . OBJECTIVES The goal of this study was to determine what proportion of ED patients currently taking sildenafil  would , after a period of treatment with tadalafil , elect to resume treatment with sildenafil at the customary dose and what proportion would elect a switch to tadalafil 20 mg for a longer period . The tolerability of both treatments was also investigated . METHODS This was a short-term , multicenter , open-label , 1-way crossover trial conducted in Sweden and Italy . Eligible patients included men aged > or=18 years with a minimum 3-month history of ED who had been taking sildenafil at stable fixed doses of 25 , 50 , or 100 mg as needed for at least 6 weeks and up to 24 weeks . The study consisted of 6 phases : a 1-week screening phase , a 3-week sildenafil assessment phase , a 1-week washout phase , a 6-week tadalafil initiation phase , a 3-week tadalafil assessment phase , and a 6-month extension phase , during which patients received their treatment of choice free of charge . The primary outcome measure was the proportion of patients electing to take sildenafil or tadalafil during the extension phase . RESULTS Of 155 men enrolled , 147 ( 97.8 % ) completed the assessment phases of the trial . Of these 147 men , 133 ( 90.5 % ) elected to receive tadalafil in the 6-month extension phase and 14 ( 9.5 % ) elected to receive sildenafil ( P < 0.001 ) . The proportions preferring tadalafil to sildenafil  were similar irrespective of age group ( > or=50 years , 92 % ; < 50 years , 90 % ) , severity of ED ( mild , 95 % ; moderate , 88 % ; severe , 96 % ) , etiology of ED ( psychogenic , 94 % ; organic , 91 % ; mixed , 87 % ) , and  sildenafil dose at study entry ( 50 mg , 90 % ; 100 mg , 89 % ) . Both medications were well tolerated . The most common treatment-emergent adverse events occurring in > or=2 % of patients during the tadalafil assessment phase included headache ( 4.8 % ) , nasal congestion ( 4.1 % ) , dyspepsia ( 3.4 % ) , flushing ( 2.7 % ) , back pain ( 2.0 % ) , diarrhea ( 2.0 % ) , and nausea ( 2.0 % ) ; the most common treatment-emergent adverse events during the sildenafil assessment phase were flusing ( 7.1 % ) , nasal congestion ( 6.5 % ) , headache ( 4.5 % ) , and nasopharyngitis ( 3.2 % ) . CONCLUSIONS In this short-term , open-label study , patients who were currently taking sildenafil for ED and then received  tadalafil preferred to continue oral therapy with tadalafil over sildenafil by a ratio of approximately 9:1 . Although the study sought to mimic the experience of actual patients receiving treatment for ED , the results are subject to potential limitations due to the design of the study , which included differences in dosing instructions and dosages for sildenafil and tadalafil . Both sildenafil and tadalafil were well tolerated INTRODUCTION The role of phosphodiesterase type 5 inhibitors in the treatment of post-radiotherapy erectile dysfunction ( ED ) has not been extensively investigated . AIM To compare the efficacy and safety of on-dem and 20-mg tadalafil ( arm A ) with the newly released tadalafil 5-mg once-a-day dosing ( arm B ) in patients with ED following radiotherapy for prostate cancer ( PC ) . METHODS R and omized study to receive on-dem and 20-mg or once-a-day 5-mg tadalafil for 12 weeks . Main Outcome Measures . Changes in the International Index of Erectile Function ( IIEF ) domain scores and Sexual Encounter Profile ( SEP ) question 2 and 3 positive response rates . RESULTS Fifty-two out of 86 screened patients were r and omized . Forty-four patients were evaluable for efficacy . A significant improvement in all domains of the IIEF was observed in both arms ( P = 0.0001 ) with mean erectile function domain scores values of 25 and 27.1 for the 20-mg and 5-mg tadalafil , respectively ( P = 0.19 ) . SEP 2 and 3 positive response rates increased from 0 % in both arms at baseline to 81 % and 70 % in the 20-mg arm and 90 % and 73 % in the 5-mg arm , respectively , at the end of treatment ( P = 0.27 ) . End of treatment global efficacy question positive answers were 86 % in the 20-mg arm and 95 % in the 5-mg arm ( P = 0.27 ) . Higher treatment compliance was shown in arm B ( 100 % ) as compared with arm A ( 86 % ) . There was a nonstatistically significant trend toward fewer side effects in favor of the 5-mg daily dose arm . CONCLUSIONS In the study population , both tadalafil formulations generated significantly high response rates according to the outcome measures and were well tolerated . The once-a-day 5-mg dosing showed higher compliance and marginally reduced side effects , thus making it an attractive alternative to on-dem and therapy for ED in post-radiotherapy PC patients AIM To compare Sexual Self-Confidence and other treatment outcomes following 8 weeks of treatment with tadalafil 5 mg once a day ( OaD ) vs. tadalafil 20 mg or sildenafil 100 mg as needed ( pro re nata [ PRN ] ) in patients with erectile dysfunction ( ED ) . METHODS A r and omized , open-label , crossover study in men ≥18 years of age with history of ED and satisfactory response to current oral phosphodiesterase 5 ( PDE5 ) inhibitor PRN . Data were analyzed with a mixed effects model for crossover design . MAIN OUTCOME MEASURES The primary outcome measure was the Sexual Self-Confidence domain of the Psychological and Interpersonal Relationship Scales ( PAIRS ) between tadalafil OaD and sildenafil PRN . SECONDARY OUTCOMES INCLUDED : Time Concerns and Spontaneity domains of PAIRS , and the Self-Esteem and Relationship ( SEAR ) scale . RESULTS Men naive to tadalafil OaD were enrolled ( N = 378 ) , with 61 - 69 % prior PDE5 inhibitor use . There were improvements in all PAIRS domains from baseline when comparing tadalafil OaD and PRN with sildenafil PRN ( P < 0.001 ) . The Sexual Self-Confidence domain improved from baseline and was 0.50 ± 0.78 following tadalafil OaD , 0.5 ± 0.72 for tadalafil PRN , and 0.39 ± 0.67 for sildenafil PRN . The difference in least-squares mean was 0.12 ± 0.04 ( confidence interval [ CI ] = 0.04 , 0.19 ; P = 0.001 ) between tadalafil OaD and sildenafil PRN and 0.01 ± 0.04 ( CI = -0.06 , 0.08 ; P = 0.872 ) between tadalafil OaD and tadalafil PRN . The Time Concerns domain score was lower with tadalafil OaD than tadalafil PRN ( P < 0.001 ) . There were no differences in SEAR scores between treatments . CONCLUSIONS Tadalafil OaD and tadalafil PRN compared with sildenafil PRN demonstrated greater improvements in Sexual Self-Confidence , Time Concerns , and Spontaneity . There was no significant difference in Sexual Self-Confidence between tadalafil OaD and tadalafil PRN . Changes in SEAR , the erectile function domain of the International Index of Erectile Function , and the Erectile Dysfunction Inventory of Treatment Satisfaction scores from baseline to end point were similar AIM To evaluate patient preferences for sildenafil citrate or tadalafil ( PDE-5 inhibitors available for the treatment of erectile dysfunction [ ED ] ) and assess potential reasons for these preferences . METHODS This open-label study was conducted on Korean men taking sildenafil , at least 6 weeks prior to study entry , for ED . Following screening , patients continued sildenafil treatment for 4 weeks , then after a 1-week washout period , switched to tadalafil for 8 weeks . Patients then continued with their treatment of choice during an extension phase . Psychosocial factors ( time concern , spontaneity , sexual self-confidence ) were evaluated using Psychological and Interpersonal Relationship Scales ( PAIRS ) , while timing of dose to sexual attempt patterns were assessed from patient diaries . RESULTS The present study enrolled 160 Korean men ( mean age 55 years ) with prior median sildenafil use of 585 days . During the extension phase , 73.7 % of patients elected to take tadalafil , whereas 26.3 % chose sildenafil ( P < 0.001 ) . After switching from sildenafil to tadalafil , mean PAIRS time concern scores decreased from 2.54 to 2.42 ( P = 0.002 ) , with no statistically significant differences observed between the sildenafil and tadalafil assessment phases in sexual spontaneity and self-confidence scores . Sexual attempts made > 4 h to =/ < 36 h post-dose occurred in 4.5 % of patients during the sildenafil assessment phase compared with 17.5 % during the tadalafil assessment phase . CONCLUSION After experiencing both sildenafil and tadalafil , the majority of patients exhibited a preference for tadalafil . This preference might be influenced by psychosocial factors , such as decreased time concerns , and a broader window of opportunity available for sexual activity INTRODUCTION Tadalafil is a phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction ( ED ) . Past clinical trials have assessed its efficacy and safety in western population s. Tadalafil has not been investigated in a large clinical trial with a South-east Asian population . AIM To assess the efficacy and safety of on-dem and tadalafil for the treatment of ED in a 12-week , double-blind , placebo-controlled study in Taiwan . METHODS Men with mild to severe ED of various etiologies were r and omized to receive placebo , tadalafil 10 mg , or tadalafil 20 mg , taken as needed ( maximum once daily ) . Efficacy assessment s included the International Index of Erectile Function , the Sexual Encounter Profile ( SEP ) diary , and a Global Assessment Question ( GAQ ) . RESULTS Tadalafil significantly improved erectile function compared with placebo ( P < 0.005 , all measures ) . At endpoint , the patients receiving tadalafil reported a greater mean per-patient percentage of successful intercourse attempts ( SEP question 3 : 70.0 % , 10 mg ; 78.0 % , 20 mg ) than placebo-treated patients ( 42.8 % ) and a greater proportion of improved erections ( GAQ : 92.3 % and 84.6 % vs. 54.5 % ) . Most treatment-emergent adverse events were mild or moderate . The most common adverse events were back pain , dyspepsia , and myalgia . CONCLUSIONS Tadalafil was an effective , well-tolerated therapy for men in Taiwan with ED of broad-spectrum severity and etiology INTRODUCTION Alpha1-blockers ( AB ) are the first-line monotherapy for lower urinary tract symptoms ( LUTS ) .  Phosphodiesterase type 5 ( PDE5 ) inhibitors are the first-line treatment for erectile dysfunction ( ED ) . Numerous studies have supposed a significant association between ED and LUTS , but a causal relationship can not be established . AIM The aim was to evaluate the efficacy of a combined therapy with an AB ( alfuzosin ) and PDE5 inhibitors ( tadalafil ) in patients with LUTS and ED . METHODS This was a r and omized , open-label , three-arm study . A total of 66 men complaining of ED and LUTS were included in the study . Patients were assessed at baseline and after 12 weeks of study treatment , and then underwent r and omized allocation to either alfuzosin 10 mg once a day ( 22 patients ) or tadalafil 20 mg on alternative days ( 21 patients ) , or a combination of both ( 23 patients ) . MAIN OUTCOME MEASURES All participants completed the erectile function domain of the International Index of Erectile Function ( IIEF-EF ) and the International Prostatic Symptom Score ( IPSS ) . Other efficacy variables included maximum urinary flow rate ( Qmax ) and medium urinary flow rate ( Qave ) . RESULTS IIEF-EF tended to improve with alfuzosin alone ( + 15 % ) , while it was clearly improved with tadalafil alone ( + 36.3 % ) . The greatest improvement was experienced with the combination therapy ( + 37.6 % ) . Improvement in Qmax was observed in all groups , but patients receiving combination therapy had greater improvement ( 29.6 % ) than patients receiving either only alfuzosin ( 21.7 % ) or only tadalafil ( 9.5 % ) . IPSS was significantly improved in alfuzosin group ( 27.2 % ) , was more marked with the combination therapy ( 41.6 % ) , and a small increase , although not significant , was also observed with tadalafil ( 8.4 % ) . CONCLUSIONS Combined therapy improved ED and LUTS as demonstrated by the significant improvement in uroflowmetry measures and in IPSS and IIEF-EF scores . A significant improvement was also observed in quality of life assessment s. The beneficial effects of tadalafil on LUTS similar to the benefits of alfuzosin on ED , although present , were smaller OBJECTIVE To examine the preference for 2 dosing regimens ( on dem and or 3 times/week ) for tadalafil , a phosphodiesterase 5 inhibitor with a duration of effectiveness up to 36 hours in men with erectile dysfunction ( ED ) . DESIGN AND METHODS SURE is a 14 European country , multicenter , crossover , and open-label study . Men with ED ( N=4262 ) were r and omized to tadalafil 20 mg treatment on dem and ( maximum one dose per day and before sexual activity ) or 3 times/week for 5 - 6 weeks . After a 1-week washout period , patients were crossed over to the alternate regimen for 5 - 6 weeks . The patient 's response to a treatment preference question ( TPQ ) was used to determine the preferred treatment regimen . RESULTS The mean age of the r and omized patients was 55 years and 85.2 % reported a history of ED for one year or greater . Overall , the responses of 3861 men to the TPQ assessment showed that 57.8 % preferred the on-dem and regimen and 42.2 % preferred the 3 times/week dosing . Both regimens were efficacious and well tolerated . CONCLUSIONS In this study , while 57.8 % of men preferred the on-dem and regimen of tadalafil 20 mg , a substantial number ( 42.2 % ) preferred the 3 times/week treatment . The two regimens provide additional treatment options by giving men with erectile dysfunction unique flexibility in dosing with tadalafil Initiation of ED treatment with a particular PDE5I may influence treatment-adherence and other outcomes . In this multicenter , open-label study , men with ED , naïve to PDE5I , were r and omized to tadalafil 5 mg once-a-day ( OaD ; N=257 ) , 10 mg on dem and ( PRN ; N=252 ) or sildenafil-citrate ( sildenafil ) 50 mg PRN ( N=261 ) for 8 weeks ( dose adjustments allowed ) , followed by 16 weeks of pragmatic treatment ( switching between PDE5I allowed ) . Primary outcomes ( treatment-adherence ) were reported previously . Here , we report effects on : Psychological and Interpersonal Relationship Scales , Self-Esteem and Relationship ( SEAR ) question naire , ED Inventory of Treatment Satisfaction ( EDITS ) , International Index of Erectile Function ( IIEF ) , Sexual Encounter Profile ( SEP ) and Global Assessment Questions ( GAQ ) . Mixed-model for repeated measures and analysis of covariance were used to analyze changes from baseline ; GAQ-responses were evaluated by logistic regression . Analyses were adjusted for treatment , country , ED-severity , baseline and baseline-by-treatment interaction . Patients r and omized to tadalafil OaD or PRN reported greater improvement ( least-square mean ( s.e . ) change ) in Sexual Self-Confidence ( OaD + 0.90 ( 0.048 ) , PRN + 0.93 ( 0.050 ) , vs + 0.73 ( 0.049 ) ; P=0.006 and P=0.001 ) and Spontaneity ( OaD + 0.11 ( 0.035 ) , PRN + 0.13 ( 0.035 ) , vs + 0.02 ( 0.035 ) ; P=0.044 and P=0.010 ) compared with sildenafil . Improvements in GAQ and SEP responses , IIEF-EF , orgasmic function , sexual desire , overall satisfaction domains , SEAR and EDITS scores did not differ significantly between treatment groups We aim ed to evaluate the effectiveness of paroxetine and tadalafil combination in the treatment of  premature ejaculation ( PE ) . A total of 150 primary (lifelong)PE patients were r and omly distributed into three groups of 50 patients each . Group 1 received 20 mg paroxetine every day for 1 month , Group 2 received 20 mg tadalafil on dem and 2 h before intercourse , and Group 3 received paroxetine and tadalafil on dem and 2 h before intercourse . Intravaginal ejaculatory latency times ( IELT ) scores were evaluated at baseline , at the end of the first month of therapy and 1 month after discontinuation of the treatment , while International Index of Erectile Function ( IIEF ) question naire scores were evaluated both prior to and after the treatment . At the end of the first month of therapy , IELT scores were compared with the basal values and statistically significant changes were detected ( 60.6 ± 30.2–117.3 ± 67.3 , 68.5 ± 21.4–110.2 ± 37.3 , 71.56 ± 40.23–175.2 ± 60.2)(P < 0.01 ) . IELT scores after discontinuation of treatment were found to be close to the baseline IELT scores ( P > 0.05 ) . IIEF scores were evaluated both prior to and after the treatment , and no statistically significant difference was detected ( P > 0.05 ) . It is concluded that utilisation of selective serotonin reuptake inhibitors ( SSRI ) and phosphodiesterase‐5 inhibitors ( PDE5i ) combination before intercourse seems to provide significantly longer ejaculatory latency times as compared with SSRI alone for a long time in patients with PE
In the meta- analysis , tadalafil and sildenafil appeared to have similar efficacies and overall adverse event rates .
However , compared with sildenafil , tadalafil significantly improved psychological outcomes .
Furthermore , the patients and their partners preferred tadalafil over sildenafil , and no significant difference was found in the adherence and persistence rates between tadalafil and sildenafil .
Additionally , the myalgia and back pain rates were higher and the flushing rate was lower with tadalafil than with sildenafil .
Conclusion Tadalafil shares a similar efficacy and safety with sildenafil and significantly improves patients ’ sexual confidence .
Furthermore , patients and their partners prefer tadalafil to sildenafil .
Hence , tadalafil may be a better choice for ED treatment
Aims Erectile dysfunction ( ED ) is a major care problem worldwide .
Tadalafil and sildenafil are the two most common phosphodiesterase 5 inhibitors used to treat ED .
This systematic review and meta- analysis were conducted to directly compare tadalafil with sildenafil for the treatment of ED .