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Medication utilization in patients receiving phosphodiesterase type 5 inhibitor for erectile dysfunction

Mulhall, JP1; Chopra, I2; Patel, D2Tang, WY3; Hassan, TA3

1: Memorial Sloan Kettering Cancer Center, United States; 2: Pharmerit, United States; 3: Pfizer Inc., United States

Objectives: Erectile dysfunction (ED) continues to have high prevalence worldwide. While phosphodiesterase type-5 inhibitors (PDE5-i) have been recommended as first line therapy, real world experience of PDE5i treatment selection and utilization patterns remains limited. The purpose of this study is to provide an update on (a) PDE5i initial selection rates, (b) patterns of respective switch, and (c) other usage, including overlapping use.

Materials & Methods: This retrospective claims study used US MarketScan Commercial and Medicare Supplement Databases from 01/2010 to 12/2015. Adult male patients with at least one ICD-9CM code of ED (607.84, 302.72) within 6 months prior to or 1 month after their first PDE5i prescription were included. Switch to a different PDE5i was reviewed at 15, 30, 45, and/or 60 days following end of days supply of initial prescription. Overlapping PDE5i utilization was defined as >2 PDE5i prescriptions in the initial prescription period. Significance was evaluated via chi-squared tests (categorical variables) or t-tests (continuous variables).

Results: Among 106,206 ED patients (age range: 18-96 years old) included in the study, a higher proportion of patients initiated on Viagra (48.7%, n=51,694) compared to Cialis (on demand and once daily) (37.8%, n=40,193) and Levitra (13.5%, n=14,319) (all p<0.001). A lower proportion of those on Viagra switched to another PDE5i within all time periods evaluated than Cialis or Levitra initiators (15, 30, 45, and 60 days; p<0.001). Those who initiated on Viagra also had lower proportion that had overlapping therapy with another PDE5i (0.4%, n=180) compared to Cialis (0.8%, n=300) and Levitra (0.6%, n=90) (all p<0.001).

Conclusion: Among a large US database, a higher proportion of ED patients initiated on Viagra, and this group had lower proportion of overlap or switch to another PDE5i treatment compared to Cialis and Levitra. This study contributes an important real world update to the current patterns of treatment utilization.


Work supported by industry: yes, by Pfizer Inc. (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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