Use of ED Drugs Associated With Lower Alzheimer Disease Risk

Among men with erectile dysfunction (ED), phosphodiesterase type 5 inhibitors (PDE5I) use vs nonuse is associated with reduced risk of developing Alzheimer disease (AD), according to study findings published in Neurology.

There are contradictory findings on the association between PDE5I and neurologic disease. Therefore, researchers of a population-based cohort study aimed to determine the effect of PDE5I on AD risk in men with ED.

Men in the UK diagnosed with ED between 2000 and 2017 were identified for the study using the IQVIA Medical Research Data (IMRD) from The Health Improvement Network (THIN) database. Eligible participants did not have exposure to PDE5I before cohort entry, which was defined as the date of ED diagnosis. A control group was also included in the analysis comprising individuals with ED and without a PDE5I prescription.

Covariates including risk factors for AD and potential confounders related to PDE5I were adjusted for at study entry. Exposure of interest was PDE5I, including sildenafil, tadalafil, vardenafil, and avanafil. The primary study outcome was the occurrence of AD during follow-up.

A total of 269,725 men with newly diagnosed ED were included in the study, of whom 148,338 (54.9%) received PDE5I. Mean age at study enrollment was 58.5 and median follow-up was 5.1 years.

At follow-up, 1119 patients developed AD, of whom 749 had exposure to PDE5I, with a crude incidence rate of 9.7 per 10,000 person-years at-risk (PYAR; 95% CI, 8.7-10.7 PYAR).

Compared with PDE5I nonusers, PDE5I users had a reduced risk for AD (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.72-0.93).

Results of the secondary analysis showed that a total of 21 to 50 or greater than 50 prescriptions of PDE5I were associated with a decreased AD risk (aHR, 0.56; 95% CI, 0.43-0.73 and aHR, 0.65; 95% CI, 0.49-0.87, respectively).

The researchers conducted a sensitivity analysis with a 1-year lag period from cohort entry and findings were consistent with the primary results (HR, 0.82; 95% CI, 0.72-0.94), but not a 3-year lag period (HR, 0.93; 95% CI, 0.80-1.08).

Limitations of the analysis were the inclusion of PDE5I exposure data based on prescription records and limited information on the real-world usage of the medications; the lack of confirmation of AD diagnosis by brain imaging scans; and potential unmeasured confounding.

“The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period,” the researchers wrote. They concluded, “To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.”

This article originally appeared on Neurology Advisor