YOUNG MEN WITH SEVERE ERECTILE DISFUNCTION ARE FREQUENTLY NOT COMPLIANT WITH PHOSPHODIESTERASE TYPE 5 INHIBITORS TREATMENT: RESULTS FROM A REAL-LIFE, CROSS SECTIONAL STUDY

Phosphodiesterase type 5 inhibitors (PDE5i) are considered first line treatment option for erectile dysfunction (ED). Despite this, high drop-out rate range from 30-50%. We aimed to investigate compliance rate and factors associated with non-adherence to first prescription of PDE5i in men seeking first medical help for ED.

Data of 1506 men seeking first medical help for ED with PDE5I prescription at a single center were analysed. Medical and sexual history was collected, including data on educational status (grouped into low (elementary and/or secondary school) and high educational level (high school and/or university degree), relationship status (stable vs. no stable), and duration of ED. Charlson comorbidity index (CCI) and total testosterone (tT) were measured. All patients completed the International Index of Erectile Function (IIEF) at baseline. Re-evaluation was performed after 3 months and patients were classified as PDE5I non-compliant (PNC) vs PDE5I compliant (PC). Descriptive statistics was used to compare the clinico-sociodemographic characteristics between PNC and PC. Logistic regression models tested the association between patients’ characteristics and PNC status.

Median age were 54 years and BMI 25.1 kg/m2. 182 (12.1%) men had a CCI > 1. A stable sexual relationship was reported by 1084 (71.9%) men. Low educational level and high educational level were found in 192 (12.8%) and 1314 (87.2%) participants. Median IIEF-erectile function (IIEF-EF) score was 16 and median ED duration was 8 months. 301 (19.9%) men were PNCs. PNC participants were younger [p < 0.001] and had lower IIEF-EF scores [p < 0.001] than PC. Serum testosterone, educational level and relationship status showed no difference. Severe ED was more common in PNC men (p < 0.01). Higher rate of PNC was noted for sildenafil (61%), vardenafil (59.7%), tadalafil (55.6%) and avanafil (46.5%) (p < 0.01). At multivariable logistic regression analysis, when accounting for PDE5I drug, younger age (OR 0.9, p < 0.001) and worse IIEF-EF (OR 0.8, p < 0.001) emerged as independent predictors of PNC.

At short term FU, ¼ of patients discontinue their PDE5I. Younger patients and worse baseline ED severity have higher probability of non-adherence to therapy. More tailored counselling towards PDE5i therapy should be performed in these patients.

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