Abstract & Commentary
By Brian R. Apatoff, MD, PhD Associate Professor of Neurology at New York Presbyterian Hospital-Cornell Campus, Assistant Editor, Neurology Alert. Dr. Apatoff is on the speaker’s bureau of Biogen, Sironea, and Teva.
Synopsis: It would be reasonable to empirically try sildeanfil and related drugs in both men and women with MS having sexual complaints.
Source: Fowler CJ, et al. A Double Blind, Randomized Study of Sildenafil Citrate for Erectile Dysfunction in Men with Multiple Sclerosis. J Neurol Neurosurg Pshchiatry. 2005;76:700-705.
This controlled, flexible dose study, with an open label extension (OLE), assessed efficacy, quality of life (QoL), and safety in men with MS and erectile dysfunction (ED). Overall, 104 men (mean age, 45; EDSS, 3.97) received sildenfil (25-100 mg) and 113 men (mean age, 47; EDSS, 4.06) received a placebo for 12 weeks. Drug efficacy was assessed by the International Index of Erectile Function (IIEF) questionnaire that includes questions on achieving and maintaining an erection, as well as a global efficacy question. MS patients receiving sildenafil had higher IIEF mean scores (P < 0.0001), and 89% (92/103) reported improved erections compared with 24% (27/112) on placebo (P < 0.0001). At the end of the OLE phase, 95% of men reported improved erections. Patients receiving placebo during the double blind phase reported a 4-fold improvement in erections once on the drug. Men receiving sildeafil also reported greater improvements in QoL measures. Adverse events were thought to be mild and did not result in discontinuation from the study.
Sexual dysfunction in both men and women with MS can result from a complicated mix of neurological deficits, medication side-effects, and psychological concerns about performance. The incidence of ED in men with MS has been reported to be up to 50-75%, making it a prominent quality of life issue in patient management. ED is commonly associated with the degree of neurogenic urinary dysfunction, so that patients with bladder issues should be queried about ED to offer treatment. Many patients are on SSRIs or other drugs that frequently contribute to loss of libido and sexual dysfunction. Occasionally, patients can have and sustain an erection, but not achieve orgasm and/or ejaculation, possibly in part from relative sensory deficits in these important sacral dermatomes. The use of supraphysiologic stimulation with strong vibrating devices can be helpful in some cases. Since sildenfil was tested in elderly and diabetics with peripheral vascular causes for ED, this controlled trial in MS patients with neurogenic ED is a reassuring validation of this therapeutic approach. Given that MS is predominantly a disorder of women, it would be helpful to see a controlled trial in female patients. Nonetheless, it would be reasonable to empirically try sildeanfil and related drugs in both men and women with MS having sexual complaints.
It would be reasonable to empirically try sildeanfil and related drugs in both men and women with MS having sexual complaints.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content