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 .
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.
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
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 .