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In the placebo group, 96% of sildenafil citrate topical cream men were taking the 100 mg dose, and 4% were taking the 50 mg dose. Download figure Open in new tab Download powerpoint. Download figure Open in new tab Download powerpoint. Download figure Open in new tab Download powerpoint. Download figure Open in new tab Download powerpoint. Quality of life variables that improved with sildenafil treatment (black bars) compared with placebo (white bars). Overall, 26/206 (13%) subjects discontinued the OLE phase (fig 1), and of these 11/106 (10%) were sildenafil naive during the DB rite aid sildenafil phase. Of the 26 subjects who discontinued, 17 (8%) did so for reasons not related to treatment (AEs, n = 3; laboratory abnormalities, n = 1; lost to follow up, withdrawal of consent, other, n = 14). The most common AEs are shown in table 2, and were comparable in nature and rate of occurrence to AEs reported in the DB phase of the study. Overall, 12 patients (6%) reported treatment emergent serious AEs during the OLE phase, most of which (n = 9) were relapses of MS or aggravation of MS symptoms, requiring hospitalisation. Seven subjects experiencing these relapses had received sildenafil during the DB phase of the study and two patients had received placebo. In all cases, the subject returned to the study and completed the OLE phase without further worsening of the MS symptoms. None of the serious AEs were attributed to the study medication. Sildenafil significantly improved erectile function and the ability price of sildenafil 50 mg to engage in satisfactory sexual activity in men with ED due to MS. Treatment with sildenafil was well tolerated, with 98% of the patients completing the study. Furthermore, oral sildenafil treatment resulted in significant improvements in both sildenafil citrate at walgreens general and disease specific QoL variables, and the treatment therefore represents an important advance in the management of ED in this group of patients. Although men participating in this study were ambulatory, indicative of their relatively mild spinal cord involvement (Kurtzke EDSS 13, 14 Although the pharmacological mechanism of sildenafil citrate 100mg cvs price sildenafil is not expected to affect desire and orgasmic function, both domains showed improvement in this current study. These improvements are thought to happen secondary to improvements in erectile function, with men feeling good about their ability to resume sexual activity and sildenafil enabling them to sustain an erection until orgasm is achieved. During the DB phase, AEs associated with sildenafil use occurred more frequently than in the placebo group, raising an issue about patients being unblinded and introducing bias when answering subjective questionnaires. However, this is a potential issue in many clinical trials and the incidence of AEs related to sildenafil treatment in this study was comparable to that in other trials, for example, in patients with diabetes, 20 depression, 21 or SCI 22 (range, 31–40%). Efficacy of sildenafil is comparable in men with ED and concomitant MS (current study) or SCI. 13, 14 The ability to achieve an erection (IIEF Q3) was improved 1.6-fold in MS patients and 1.8-fold in SCI patients, whereas the ability to maintain an erection (IIEF Q4) improved 1.9-fold in MS patients and 2.1-fold in SCI patients. From the GEQ, the percentage of MS patients reporting improved erections was 90% for sildenafil users compared with 24% for placebo users; the percentage of SCI patients reporting improved erections was 75% for sildenafil users compared with 7% of placebo users. These data demonstrate that patients with ED due to spinal disease respond well to treatment with sildenafil. The results are comparable to or better than a population of patients with ED of mixed etiology (72–79%) 23 and markedly higher than in patients with diabetes mellitus (48–72%), 24 whose poorly preserved vasculature might be the main reason for low efficacy. Interestingly, there appears to be a greater efficacy of sildenafil in patients with MS than in patients with diabetes, since 64% of men with MS preferred the 100 mg dose, compared with 75% of men with diabetes choosing that dose. Moreover, greater efficacy in patients with MS may be due to the fact that sildenafil acts peripherally, and although pyschogenically driven erections are likely to have been impaired by spinal cord disease, reflexogenic responses, subserved by sacral segmental pathways, are still intact.
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