Abstract
We evaluated the effects of different nutraceutical formulations widely available worldwide as alternative treatment strategies in improving erectile function in men with erectile dysfunction (ED) using a network meta-analysis (NMA) approach.
A search of PubMed, Scopus, Cinahl, and Cochrane Library was performed, limited to studies using IIEF-score, published through September 2023. To facilitate the efficacy rating for individual nutraceutical treatments, we excluded studies in which more than three different molecules were used in combination in the same group. We performed direct pairwise meta-analyses and then a frequentist random-effects NMA to incorporate estimates from direct and indirect comparisons. The surface area under the cumulative classification curve (SUCRA) expresses the percentage of effectiveness of each treatment relative to an “ideal” treatment, using values range from 0 to 100%.
The included 16 RCTs investigated 13 nutraceutical preparations. At the NMA forest plot (Figure 1), when compared with placebo, significant improvements in IIEF score were induced by L-arginine, acetil L-carnitine (ALC) + propionil L-carnitine (PLC), L-arginine + Tadalafil, ALC + PLC + Sildenafil. Among the different nutraceutics, the association between ALC, PLC and sildenafil was associated to the highest SUCRA (0.96), followed by the association between L-arginine and Tadalafil (0.84), ALC + PLC (0.79) and L-arginine (0.55).
In the context of the widespread ineffectiveness of most nutraceutical preparations, this NMA of available RTCs has identified a small group of compounds that are potentially useful in ED, particularly when used in combination with PDE5 inhibitors. The combination of ALC and PLC, especially in the presence of Sildenafil, and L-Arginine, especially in combination with Tadalafil, produced higher IIEF score improvements. These findings should be interpreted with caution, but are of value in narrowing the field to a small number of compounds whose actual efficacy needs to be confirmed through targeted prospective studies in patients of ED of different etiologies.
We have no conflicts of interest to disclose.
