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Medical Pike Briefs : Headline Index : Erectile Dysfunction
Viagra pill
Viagra by the Numbers
Compared with MUSE, Vasomax,
and Ginkgo Biloba for Erectile Dysfunction

Ginkgo Biloba Fails Erection Test

June 2, 1998. A double blind study of oral treatment with ginkgo biloba extract for erectile dysfunction in men with suspected vascular-related impotence has failed to find any striking benefits.
Ginkgo leavesAt the start of the trial, 32 men received a standardized diagnostic work-up. Then they were either given 240 mg of ginkgo biloba extract per day or placebo.
    Twenty-three patients took part in a 24-week treatment cycle. Nine patients had dropped out. The researchers say: "In contrast to an uncontrolled pilot study, a placebo-controlled, double-blind evaluation could not prove any benefit from treatment with oral Ginkgo biloba extract for patients with erectile dysfunction."

Michael H. Sohn et al: Randomized Placebo-Controlled Study on the Effects of Oral Treatment with Ginkgo Biloba Extract in Patients with Erectile Dysfunction.

In Uro's Office, MUSE "Disappoints"

June 2, 1998. Published clinical trials of MUSE (Intraurethral alprostadil) for treating erectile dysfunction (ED) show good results. But a team of urologists decided to investigate further after seeing disappointing results in their own clinical practice. They decided to run their own trial.
    They recruited 115 male patients, all about 65 years old and all with a regular sexual partner. About half of the patients were college-educated. On a scale of 1 to 10, they rated their health at 8.1, but their sexual functioning at 3.5. Most of the men had either had surgical treatment for prostate cancer or suffered from diabetes.
    The men received in-office treatment with increasing doses of MUSE. After use, the men gave a self-rating on penile rigidity from 1 to 5, plus a personal level of comfort rating. The ratings 4 and 5 were considered sufficient for intercourse. The patients also received blood pressure checks at 15-minute intervals.
    Peak rigidity was achieved at 30 minutes with a score of 2.6 at 250 mcg, 2.4 at 500 mcg, and 2.9 at 1000 mcg. Only 27% of the patients achieved rigidity sufficient for intercourse despite being challenged to the highest doses.
    According to the researchers, discomfort was maximal at 15 minutes with ratings of 3.5 (250 mcg), 3.7 (500 mcg), and 4.2 (1000 mcg). Blood pressure decreased significantly at 15 and 30 minutes. Penile pain and burning were the most common adverse events. At follow-up, according to the researchers only 18.6% of the patients continued to use the system, while the majority chose alternate treatments.
    The investigators concluded: "For a variety of possible reasons efficacy in a controlled clinical trial has not translated into clinical usefulness of the MUSE system for the majority of our patients suffering from ED." Pat F. Fulgham et al, Disappointing Results with Transurethral Alprostadil in Men with Erectile Dysfunction (ED) in a Urology Practice Setting

Vasomax OK for "Mild" ED

How many physicians will prescribe Vasomax (oral phentolamine) now that Viagra is widely available? In a recent study, out of 148 patients who took 40 mg of oral phentolamine, 50 (34%) responded. Out of 145 patients on placebo, 30 (21%) responded.
    Vasomax, the researchers conclude, is safe and effective for minimal erectile dysfunction. They also report that ten percent of those who received the drug experienced side effects including headache and facial flushing.

Viagra Wins Over Placebo by 5 to 1

Of a total of 3,361 men who had severe erectile dysfunction (ED), 60% involved males with organic ED, 15% had psychogenic problems, and 25% had mixed difficulties. These men made up the population of patients tested in a total of 10 separate studies whose results were then merged for purposes of "meta-analysis."
     The studies were double-blind, placebo-controlled, fixed dose or flexible dose studies. Over an 8-week period, patients took sildenafil or placebo, as needed, 1 hour prior to sexual activity. The frequency of penetration and the frequency of maintained erections was assessed at baseline and at week 8 using the 15-item self- administered International Index of Erectile Function.
    Responses were from 0 (did not attempt intercourse) or 1 (almost never/never) to 5 (almost always/always). Severe ED was defined as a baseline score of 0 or 1.
    In this analysis, responders were defined as patients who had a score greater than 4 or those whose final score increased by greater than 1. Of 819 men on sildenafil, 377 (46%) had a score greater than 4 on penetration and 393 (48%) had a score greater than 4 on maintaining an erection. Placebo responders averaged 8%.
    Responders who had a final score increase greater than 1 averaged from 71% to 73%. According to the investigator, the results of this meta-analysis of sildenafil at 50 and 100 mg doses show it is effective in men with severe ED. Meta-Analysis of the Efficacy of Sildenafil (ViagraTM) in the Treatment of Severe Erectile Dysfunction
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August 6, 1998. Page modified December 26, 1998

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