(042) EFFICACY AND SAFETY OF ON-DEMAND THERAPY WITH CLOMIPRAMINE/SILDENAFIL COMBINATION COMPARED TO ON-DEMAND THERAPY WITH CLOMIPRAMINE OR SILDENAFIL ALONE IN PATIENTS WITH PREMATURE EJACULATION: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED, ACTIVE-CONTROLLED, 3-T
Authors: Moon DG , Lee WK , Kam SC , Park HJ , Park HJ , Kim SW , Kim JH , Kim TH , Ryu JK , Kim SW , Lee SW 
Published: December 2024

Abstract

Introduction
Premature ejaculation (PE) is one of the most common male sexual dysfunctions with various treatment options. Clomipramine is commonly used for PE in clinical practice, and is considered first-line pharmacotherapy in recent AUA guidelines. Sildenafil is the best-known drug for erectile dysfunction (ED), and has also shown a positive effect for PE in several clinical trials. Meanwhile, many studies have demonstrated that several selective serotonin reuptake inhibitors (SSRIs) combined with sildenafil is superior to SSRI or sildenafil monotherapy for PE. However, to our knowledge, there are no studies on the utility of clomipramine combined with sildenafil.

Objective
We assessed the efficacy and safety of on-demand therapy with clomipramine 15 mg/sildenafil 50 mg combination compared with clomipramine or sildenafil alone in men with PE without ED.

Methods
Our prospective, randomized, double-blinded, active-controlled, 3-treatment arm, multi-center trial enrolled 795 men with PE without ED. Subjects were recruited between October 2019 and April 2022 at 24 institutions in Korea. PE was defined as (1) history on DSM-V, (2) PEDT ≥11 score, and (3) IELT &lt;3 minute. Subjects were divided into three groups: clomipramine 15 mg (group A, n = 265), sildenafil 50 mg (group B, n = 266) and clomipramine 15 mg/sildenafil 50 mg (group C, n = 264). During 12 weeks, stopwatch-measured IELT and patients reported outcomes (PEP, PGIC) were measured. Any treatment-emergent adverse events (TEAEs) were also recorded.

Results
Over 12 weeks, IELT increased by 191.72 ± 12.72 seconds (p &lt; 0.001), 168.35 ± 12.29 seconds (p &lt; 0.001), and 279.41 ± 20.06 seconds (p &lt; 0.001) in group A, B and C, respectively. Increase of IELT was significantly greater in group C than in group A or group B (each p &lt; 0.001). In PEP score, the improvement rates were 91.46%, 85.59%, and 96.10% in groups A, B, and C, respectively. Improvement rate of PEP score was higher in group C than group A or B (p = 0.037 and &lt; 0.001, respectively). In PGIC score, the improvement rates were 41.87%, 34.50%, and 54.98% in groups A, B, and C, respectively. Improvement rate of PGIC score was higher in group C than group A or B (p = 0.004 and &lt; 0.001, respectively). TEAEs occurred in 17.36%, 16.17%, and 25.00% of groups A, B, and C, respectively. TEAEs in group C seemed to occur more frequently than in groups A or B, but there was no statistical difference between groups (p = 0.098). In each group, TEAEs occurred frequently in the following order: nausea (7.92%), dizziness (3.02%) and dyspepsia (2.26%) in group A; headache (4.89%), flushing (4.14%) and dizziness (3.01%) in group B; headache (9.09%), nausea (7.58%), flushing (7.95%) and dizziness (3.41%) in group C. Almost all TEAEs were mild to moderate (99.58%), and there was no serious TEAE.

Conclusions
On-demand therapy with clomipramine 15 mg/sildenafil 50 mg combination showed better results in terms of IELT, PEP and PGIC, and was similar in safety, compared to that with clomipramine 15 mg or sildenafil 50 mg alone. Our results support the suggestion that the on-demand therapy with clomipramine/sildenafil combination have a potential role in the treatment of PE without ED.

Disclosure
No.