BackgroundPhosphodiesterase 5 inhibitors (PDE5is) represent a first‐line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription.ObjectiveWe aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription.Materials and methodsData from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i‐naïve and non‐PDE5i‐naïve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i‐naïve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i‐naïve versus non‐PDE5i‐naïve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i‐naïve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i‐naïve at baseline.ResultsOverall, 1,491 (70.9%) patients were PDE5i‐naïve and 611 (29.1%) were non‐PDE5i‐naïve at the first assessment. PDE5is‐naïve patients were younger, with a lower prevalence of CCI ≥ 1 and of normal erectile function (EF) than non‐PDE5i‐naïve men (all p < 0.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF‐EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i‐naïve at baseline. Univariate LRA revealed that younger patients (Coeff: −0.02), with lower CCI (Coeff: −0.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i‐naïve over the analyzed timeframe. Moreover, for the same IIEF‐EF score, patients with higher CCI had lower probability of being PDE5i‐naïve.ConclusionsSelf‐prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use.

中文翻译：

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第一次调查勃起功能障碍时未接受过 PDE5 治疗的患者与未接受过 PDE5 治疗的患者相比——来自长期、现实生活横断面研究的结果

背景磷酸二酯酶 5 抑制剂 (PDE5is) 是治疗勃起功能障碍 (ED) 的一线药物疗法。男性无需任何适当的医疗处方即可出于娱乐目的获得 PDE5is。目的我们旨在分析在没有事先正式医疗处方的情况下已使用任何 PDE5i 治疗 ED 的患者的临床特征。材料和方法数据来自 2012 年因 ED 寻求首次医疗帮助的异性恋、性活跃男性对 2005 年至 2022 年期间我们门诊的患者进行了分析。所有患者均接受了全面的性史和病史评估，并在基线时完成了国际勃起功能指数（IIEF）。使用查尔森合并症指数（CCI）对合并症进行评分。其中，根据首次就诊前是否接触过 PDE5i，将患者分为：未接触过 PDE5i 的患者和未接触过 PDE5i 的患者。描述性统计检验了两组的社会人口学和临床特征。逻辑回归模型预测了基线时未使用 PDE5i 的可能性。线性回归分析 (LRA) 估计了在分析的时间范围内未接触过 PDE5i 的可能性与未接触过 PDE5i 的可能性。最后，局部多项式回归模型以图形方式探讨了在分析时间范围内首次临床评估时未使用 PDE5i 的可能性，敏感性分析测试了基线时未使用 PDE5i 的概率。结果总体而言，1,491 名患者 (70.9%) 患有 PDE5i首次评估时，611 名 (29.1%) 未曾接受过 PDE5i 治疗。与未接受 PDE5i 治疗的男性相比，未接受过 PDE5i 治疗的患者更年轻，CCI ≥ 1 的患病率较低且勃起功能 (EF) 正常（EF）p< 0.05）。多变量逻辑回归发现，BMI 较低（OR：0.99）、IIEF-EF 评分较高（OR：1.02）、严重 ED 发生率较低（OR：0.94）以及在整个研究时间范围内较早接受评估的患者（OR： 1.27）在基线时不太可能是 PDE5i 未接触过的。单变量 LRA 显示，在分析的时间范围内，年轻患者（Coeff：-0.02）、CCI 较低（Coeff：-0.29）和每周酒精摄入量较高（Coeff：0.52）的患者更有可能未患过 PDE5i。此外，对于相同的 IIEF-EF 评分，CCI 较高的患者未接触过 PDE5i 的概率较低。 结论 自我处方 PDE5i 是普通人群中存在的一种态度，尽管这种现象随着时间的推移而减少。目前的数据概述了继续开展教育活动以宣传 PDE5is 作为有效和安全的医药产品的重要性，同时避免其不当使用。