Regular use of erectile dysfunction medicines tied to ocular adverse events: JAMA

Canada: Regular phosphodiesterase type 5 inhibitors (PDE5Is) users may be at a higher risk of developing retinal vascular occlusion (RVO), serous retinal detachment (SRD), and ischemic optic neuropathy (ION), says an article published in the JAMA Ophthalmology. 

A variety of case reports and smaller epidemiologic studies have estimated the risk of ocular adverse effects related to PDE5Is inhibitor treatment. However, the findings have been contradictory, and there is a lack of epidemiologic data on the risk of RVO and SRD. As a result, Mahyar Etminan and colleagues undertook this study to estimate the risk of SRD, RVO, and ION linked with the usage of PDE5Is.

The data for this cohort research, which included a nested case-control analysis, were gathered from the PharMetrics Plus database (IQVIA) between January 1, 2006, and December 31, 2020. Cohort participants were tracked until they received their first diagnosis of SRD, RVO, or ION, or until their insurance coverage expired. Using density-based sampling, four controls were matched to each case based on age and time of study enrollment. After controlling for potential confounding factors, the risk for regular PDE5I users was compared to that of nonusers. Cases having SRD, RVO, or ION diagnoses in the year preceding the cohort were eliminated.

The key findings of this study were as follow:

1. The study included 213 033 males who were using PDE5Is such as tadalafil, sildenafil, vardenafil, and avanafil.

2. The case-control study comprised 1146 cases with SRD (278), RVO (628), ION (240), and 4584 controls, with a mean age of 64.6 years in both groups.

3. Hypertension, diabetes, coronary artery disease, and sleep apnea were more common in patients with SRD, RVO, and ION.

4. For the composite end points of any of the three outcomes, the corrected IRR was 1.85. Individually, the corrected IRR for SRD, RVO, and ION was 2.58, 1.44, and 2.02, respectively.

In conclusion, PDE5I users should be aware of the ocular side effects connected with these medications and notify their doctors if they encounter any visual impairments.

Reference:

Etminan M, Sodhi M, Mikelberg FS, Maberley D. Risk of Ocular Adverse Events Associated With Use of Phosphodiesterase 5 Inhibitors in Men in the US. JAMA Ophthalmol. Published online April 07, 2022. doi:10.1001/jamaophthalmol.2022.0663