Anti-Inflammatory Priming Enhances the Anti-Erectile Dysfunction Efficacy of PDE5 Inhibitors

Background: Pieces of evidence have long been accruing about the contributory role of low-grade systemic inflammation as a co-determinant of erectile dysfunction. Inflammation and disruption of local microcirculation could also interfere with the full efficacy of PDE5 (phosphodiesterase type 5) inhibitors. The idea-generating pilot study herein described attempted to explore whether attenuating such pro-inflammatory contribution to the erectile dysfunctional milieu with the help of a dietary supplement could enhance the efficacy of PDE5 inhibitors.

Methods: Study Design: Prospective cohort pilot study (14 subjects diagnosed with moderate erectile dysfunction) with an end-of-study comparison of final treatment outcomes vs a random sample of ED (erectile dysfunction) recent historical controls from the author's urology ward.

Cohort Treatment One-month background anti-inflammatory priming with a dietary supplement of acknowledged anti-inflammatory and capillary protective properties (one 1-g tablet once daily) followed by three months of alternating every-other-day treatment with 25-mg sublingual sildenafil or the dietary supplement.

Assessments: comparison of the overall skewness of the cohort distribution of IIEF-5 (simplified International Index of Erectile Function) scores before and after the treatment period, and purely exploratory comparison of the end-of-study EEIF-5 mean scores of the prospective cohort and the sample of historical controls.

Results: Strong left skewness of the IIEF-5 frequency distribution at the end of the study compared to the basal score distribution suggests controlling background inflammation might indeed be of value. EEIF-5 mean scores, prospective active cohort vs ED historical controls: 20.4 vs 14.0.

Conclusions: The exploratory comparison of end-of-treatment mean IIEF-5 scores in the active cohort vs historic controls gives some preliminary support to the idea that modifying the pro-inflammatory erectile dysfunctional milieu with the anti-inflammatory dietary supplement might indeed have contributed to the overall efficacy of the anti-ED treatment and enhanced the 3-month efficacy of sublingual sildenafil. Further investigations are warranted to confirm these preliminary suggestions.