Efficacité et tolérance des IPDE-5 dans le traitement de la dysfonction érectile chez le patient schizophrène : une revue de la littérature - 12/02/17
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Résumé |
Les dysfonctions sexuelles sont fréquentes chez les patients schizophrènes. Elles ont été associées notamment aux traitements antipsychotiques avec des conséquences sur la qualité de vie des patients, l’observance des traitements, et le coût de santé publique. Les inhibiteurs de la phosphodiesterase de type 5 (IPDE-5) pourraient être utilisés chez les patients schizophrènes pour lutter contre les dysfonctions érectiles. Cette revue de la littérature a pour objectif de faire la synthèse des données actuelles concernant l’efficacité et la tolérabilité des IPDE-5 dans le trouble érectile chez le patient schizophrène. Seulement 6 essais thérapeutiques correspondent aux critères recherchés dont 3 essais randomisés, en double insu et cross-over. Au total, malgré certains résultats discordants, les données actuelles laissent présumer une efficacité et une bonne tolérance de l’utilisation des IPDE-5 chez les patients schizophrènes souffrant de dysfonction érectile. Davantage d’études doivent être réalisées afin de conclure à l’utilisation des IPDE-5 chez les patients schizophrènes.
Le texte complet de cet article est disponible en PDF.Abstract |
Introduction |
Sexual dysfunction is an important public health problem in men and is associated with reduced quality of life. It is more common in patients with schizophrenia. It is well-established that antipsychotic drugs cause sexual dysfunction with consequences on the quality of life of patients, adherence to treatment, and public health costs. Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are indicated for the management of erectile dysfunction. However, there is little information on such treatment in schizophrenic patients. This literature review aimed to summarize the current data on the efficacy and tolerability of PDE-5 inhibitors in the erectile dysfunction in schizophrenic patients.
Material and methods |
PubMed, PsycInfo and Cochrane databases were searched for studies published until August 2014.
Results |
Only 6 studies met the inclusion criteria. Three were randomized, double-blind, cross-over, placebo-controlled trials and three were open studies. Various scales were used to measure erectile and orgasmic function, desire, satisfaction during intercourse, overall satisfaction, quality of life and intensity of schizophrenic symptoms. In the 3 randomized studies (one with sildenafil 25–50 mg, one with lodenafil carbonate 80 mg/j and the last one with tadalafil 10 mg), the rate of participants who completed the trial was high (around 95 %). All three included patients with schizophrenia or schizophrenia spectrum disorders. Patients reported significant improvement on sexual dysfunction. However, no statistical difference was reported between lodenafil and placebo, on different scales, suggesting a very important placebo effect in patients with schizophrenia. All three found a good tolerance of PDE-5 inhibitors. Side effects were rare and were mainly nasal congestion, headaches, nausea and dizziness. There were no major side effects or drug interactions. Considering the 3 open studies, 2 involved sildenafil and one tadalafil. All concluded in improved erectile and orgasmic function, desire, satisfaction during intercourse, overall satisfaction, and even the quality of life when it was studied. However, very few patients were included.
Discussion |
Little data are available on the use of PDE5 inhibitors in schizophrenic patients. The 6 studies included few patients which reduces the power and the scope of their conclusions. There is also an important bias due to the use of self-questionnaires. The methodologies of the studies differ in many aspects which limits the comparability. Inclusion and exclusion criteria, drugs used and scales varied among the studies. However, the management of erectile disorder seems to be a consistent target in an integrative approach for the overall well-being of schizophrenic patients. PDE-5 inhibitors appear to be safe and could improve erectile function in schizophrenic patients.
Conclusion |
In total, the current data suggest efficiency and good tolerance of the use of PDE-5 inhibitors in schizophrenic patients with erectile dysfunction. However, further studies focusing on PDE-5 inhibitors are needed to more deeply assess their efficacy and safety in patients with schizophrenia.
Le texte complet de cet article est disponible en PDF.Mots clés : Dysfonction érectile, Dysfonction sexuelle, IPDE-5, Schizophrénie
Keywords : Erectile dysfunction, Sexual dysfunction, Phosphodiesterase type 5 inhibitor, Schizophrenia
Plan
Vol 43 - N° 1
P. 55-61 - février 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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