Daily tadalafil helps recover erectile function in young men with ED

Nearly one in two young men with primary psychogenic erectile dysfunction (ED) treated with tadalafil 5 mg once daily achieve spontaneous medication-free erectile function (EF) at 3 months, as shown in a study. Younger patients tend to have a higher chance of recovery after drug discontinuation.

“These insights are essential for healthcare providers to more accurately identify the patients who are most likely to benefit from a temporary course of tadalafil 5 mg once a day, ultimately enhancing sexual spontaneity and overall patient satisfaction,” the investigators said.

This study analysed data from 96 consecutive patients aged <50 years who sought medical help for ED and were prescribed tadalafil 5 mg. These patients completed the International Index of Erectile Function (IIEF) and underwent baseline penile color Doppler ultrasound. They also undertook clinical assessments or phone interviews during follow-up.

Spontaneous medication-free EF recovery was characterized by IIEF EF domain score >22 following tadalafil discontinuation, prompting cessation of follow-up.

The investigators compared tadalafil responders and nonresponders through descriptive statistics. They also examined the relationship between baseline characteristics and EF recovery risk after drug discontinuation using Cox regression hazard models. EF recovery probability over time was estimated via Kaplan-Meier analyses.

Of the patients (median age 39 years) analysed, 82 (85.4 percent) achieved EF recovery after discontinuing tadalafil use, whereas 14 (14.6 percent) showed no response. The median usage time of tadalafil from beginning to cessation was 3 months. Headache was the most common treatment-emergent adverse event, occurring in nine (9.4 percent) patients. [J Sex Med 2024;21:671-675]

Nonresponders tended be older (43 vs 38 years; p=0.03), have higher BMI (25.5 vs 23.6 kg/m²; p=0.04), and have lower baseline IIEF EF domain scores (12 vs 15; p=0.02) than responders. Nonresponders and responders, however, showed no difference in baseline ED severity, Charlson comorbidity index, smoking, alcohol intake, regular physical exercise, and color Doppler ultrasound parameters.

The younger, the better

In Cox regression analysis, younger age (hazard ratio, 0.95, 95 percent confidence interval, 0.92‒0.99; p=0.01) appeared to predict EF recovery following adjustments for baseline ED severity, BMI, smoking, and Charlson comorbidity index ≥1.

The Kaplan-Meier analysis revealed the probability of EF recovery over time, with rates of 43 percent, at 3-month, 60 percent at 6-month, and 72 percent at 12-month follow-up intervals.

“Tadalafil 5 mg once a day is an effective short-term treatment for psychogenic ED, allowing its discontinuation after achieving a normal medication-free EF,” the investigators said.

Prior studies that examined daily tadalafil for ED treatment found generally positive results. One randomized clinical trial by Porst and colleagues demonstrated that tadalafil once-a-day regimen resulted in EF improvements and was well tolerated. [Eur Urol 2006;50:351-359]

The current study was limited by the small number of participants and the possible neglect of confounding factors, according to the investigators.

“To validate these preliminary findings, further research involving a larger and more heterogeneous cohort is necessary,” they said.