Study Finds Association Between Erectile Dysfunction Treatments and Reduced Risk of Alzheimer Disease

In a large population-based cohort study, researchers found an association between the initiation of phosphodiesterase type 5 inhibitors (PDE5Is), a targeted therapy widely used to treat erectile dysfunction (ED), and a lower risk of Alzheimer disease (AD) when compared with those with ED who did not have a prescription for PDE5Is. While their study indicates an association, the results do not prove that ED treatments reduce the risk of AD.

Researchers used data from the IQVIA Medical Research Data UK to identify men from the United Kingdom 40 years of age or older with a new ED diagnosis between 2000 and 2017. The comparison group was also men newly diagnosed with ED who did not have a prescription for PDE5I (nonusers). After exclusions, the study included 269,725 men with a mean age of 58.5 years. A total of 1119 men were newly diagnosed with AD during a median follow-up of 5.1 years. The researchers set the primary outcome as the first recording of AD during follow-up, which was identified using diagnostic read codes linked to its clinical diagnosis.

The results of the study showed that PDE5I initiation was associated with a lower risk of AD (adjusted hazard ratio [HR] = 0.82 [95% CI, 0.72 to 0.93]) compared with those who did not use PDE5Is. The researchers noted that the risk decreased with higher prescription frequency, with HRs of 0.56 (95% CI, 0.43 to 0.73) for 21 to 50 prescriptions and 0.65 (95% CI, 0.49 to 0.87) for greater than 50 prescriptions.

“The greatest risk reduction was observed in those issued greater than 20 prescriptions over a median follow-up of 5 years,” the authors wrote.

Sensitivity analysis with a 1-year lag period supported the primary findings (HR = 0.82 [95% CI, 0.72 to 0.94]), but a 3-year lag period did not offer a strong association (HR = 0.93 [95% CI, 0.80 to 1.08).

This study had limitations, most notably, that the data involving PDE5I exposure was based on prescription records. The researchers could not be certain whether the patients collected or used the prescribed treatment.

The authors noted that further study covering a wider population, preferably a randomized controlled trial, is still needed to confirm their results.

“Such a study would include male and female participants, without cognitive impairment, randomized to receive a PDE5I in predefined doses or placebo,” the authors concluded. “The primary outcomes would be the change in baseline cognitive function. This approach would provide a comprehensive understanding of the potential therapeutic benefits of PDE5I and AD.”

Reference:
Adesuyan M, Jani YH, Alsugeir D, et al. Phosphodiesterase type 5 inhibitors in men with erectile dysfunction and the risk of alzheimer disease: a cohort study. Neurology. 2024;102(4):e209131. doi:10.1212/WNL.0000000000209131.