Current Pharmacological Management of Premature Ejaculation: A Systematic Review and Meta-analysis

Context: Premature ejaculation (PE) is the most prevalent male sexual dysfunction. In the last few years, several pharmacologic approaches for oral or topical treatment of PE have been studied. Objective: To systematically review the literature on the outcome of pharmacologic interventions for PE on intravaginal ejaculation latency time (IELT) in comparison to placebo. Evidence acquisition: A systematic literature search of PubMed and Scopus using the term premature ejaculation was performed on 10 April 2015. Full-text articles on prospective randomized controlled trials (RCTs) investigating pharmacotherapy were included. The main outcome measure was IELT. Evidence synthesis: Out of 266 unique records, a total of 22 were reviewed. The majority of RCTs were of unclear methodological quality because of limited reporting of methods. Pooled evidence suggests that selective serotonin reuptake inhibitors (SSRIs), topical anesthetic creams (TAs), tramadol, and phosphodiesterase type 5 inhibitors (PDE5is) are more effective than placebo at increasing IELT (all p < 0.05). However, interpretation of the current meta-analyses may be impaired as a result of frequent heterogeneity in the pooled analyses (all I-2 > 70%). Only pooled analyses for dapoxetine 30 mg and 60 mg were characterized by homogeneous data (both I-2 < 30%) while showing a modest but statistically significant improvement in IELT compared with placebo (mean difference 1.39 min, 95% confidence interval 1.23-1.54 min; p < 0.00001). Conclusions: Meta-analysis revealed that treatment with dapoxetine significantly improves IELT in patients with PE but with modest efficacy. The efficacy of SSRIs, TAs, tramadol, and PDE5is remains unclear owing to high heterogeneity of the available RCT data. There is a persisting need for drug research and development in the field. Patient summary: Premature ejaculation is a condition for which the cause is not well understood. Several types of treatment with medium to low efficacy are available. More research is necessary to identify the ideal treatment. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.