TCAS 11. Planning therapy: A new strategy for treating ED
Since the first kind of phosphodiesterase type 5 inhibits, sildenafil was appoved by FDA to treat erectile dysfunction, the goal of the therapy is to make the patients achieve successful intercourse with the help of PDE-5i. Few doctors would treat ED as a disease like hypertesion, diabetes mellitus, cardiovascular diseases and so on. Most patients with ED would like to know whether ED can be cured and how long they need to take the medicine. We cannot tell the patients the results exactly in fact. However, we believe that some types of ED can be cured. We attempt a new therapy strategy for ED in clinical practiceplanning therapy.
Traditional medication for ED is to take PDE-5I just before intercourse in order to make patients achieve a successful intercourse. The planning therapy is other than traditional therapy. The planning therapy has courses of treatment and criterion of decreasing dosage or stopping medicine, however, in traditional therapy PDE-5I is taken in an on-demand schedule of administration. The goal of planning therapy is to cure ED or achieve the maximum effect with the minimus dosage.
We believe ED should be treated as a disease like hypertension, diabetes mellitus, cardiovascular diseases and so on. Treatment outcome should be divided into 3 category: cure, improvement and inefficiency. Some patients such as psychological ED, mild or medium ED should be cure.
A prospective, randomized, controlled trial demonstrated that chronic sildenafil administration could restore normal sexual function. Seventy-six patients were randomly assigned to 50 mg of sildenafil every night at bedtime (group 1), 50- 100 mg of sildenafil on demand (group 2), or follow-up without any medical therapy (group 3) for one year. Each treatment group underwent a washout phase (one and six months in groups 1 and 2, respectively). Treatment efficacy was assessed after 12 and 13 months by means of International Index of Erectile Function (IIEF). After the one-month washout phase, a significantly higher percentage of patients in group 1 had restored normal EF (IIEF domain score≥26) compared with group 2 (60% vs. 10%). The differences in restoring EF among groups were maintained even after the washout phase; six months after protocol termination, 95% of patients in group 1 who had restored EF after treatment maintained potency, according to long-term IIEF EF domain score analysis. Thus, these results seem to suggest a sustained significant regression of ED after one year of daily treatment with sildenafil, even after drug therapy termination.
Planning therapy may decrease the patients' concern and worry about erectile function, improve the endothelia function, restore sexual function. We often administer sildenafil 100 mg twice a week or tadalafil 10 mg once at night which is dependant on ED of patients. Different patients have different courses of treatment. We demand the patients to receive therapy for one month at least and begin to decrease the dosage after satisfactory intercourse eight to twelve times at least. There is not exact definition about cure of ED, but we believe such patient is be cured that he can achieve successful intercourse without the help of PDE-5I for some time.
There are not definite courses of treatment and exact criterion of cure. We need to observe more patients and gather the outcomes to form a consummate therapy model. Although the theory of planning therapy is not popular, we believe more patients will benefit from planning therapy than traditional ondemand therapy.
