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

Arcangelo Barbonetti1, Daniele Tienforti1, Federica Antolini1

  • 1Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, 67100, Italy.

The Journal of Sexual Medicine
|September 16, 2024
PubMed
Summary

Most nutraceuticals are ineffective for erectile dysfunction (ED). However, L-Arginine and propionyl L-carnitine (PLC) + acetyl L-carnitine (ALC) show promise, particularly when combined with PDE5 inhibitors for organic ED.

Keywords:
antioxidantsdietary supplementsoxidative stressphosphodiesterase 5 inhibitorssexual dysfunctionsexuality

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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.