Nutraceutical interventions for erectile dysfunction: a systematic review and network meta-analysis

Area of Science:

• Urology
• Nutritional Science
• Pharmacology

Background:

• Erectile dysfunction (ED) treatments often include nutraceuticals, but their effectiveness is questionable due to limited comparative studies.
• Lack of head-to-head trials makes choosing between nutraceuticals difficult.

Purpose of the Study:

• To compare the efficacy of nutraceutical interventions for ED using a network meta-analysis (NMA).
• To evaluate nutraceuticals alone or combined with phosphodiesterase type 5 inhibitors (PDE5i) in improving erectile function.
• To establish a hierarchy of effectiveness for various treatment regimens.

Main Methods:

• Conducted a systematic search of major databases for randomized placebo-controlled trials (RCTs) on nutraceuticals for ED.
• Performed random-effects network meta-analyses (NMAs) to rank treatment efficacy using surface under the cumulative ranking curve (SUCRA).
• Analyzed organic and non-organic ED separately and used league tables for reciprocal comparisons.

Main Results:

• Fifteen RCTs involving 1000 men with ED were analyzed.
• The combination of propionyl L-carnitine (PLC) + acetyl L-carnitine (ALC) + Sildenafil showed the highest efficacy (SUCRA 97%), followed by L-Arginine + Tadalafil (84%).
• In organic ED, PLC + ALC and L-Arginine enhanced Sildenafil and Tadalafil efficacy, respectively; no such benefit was observed in non-organic ED.

Conclusions:

• Most nutraceutical interventions show limited effectiveness for ED.
• L-Arginine and the PLC + ALC combination demonstrate potential utility, especially when combined with PDE5 inhibitors in organic ED.
• This NMA provides valuable insights into nutraceuticals for ED management.