medwireNews: Long-term use of dulaglutide may reduce the incidence of moderate or severe erectile dysfunction in men with type 2 diabetes, especially those with underlying cardiovascular disease (CVD), shows an exploratory analysis of REWIND data.
In The Lancet Diabetes & Endocrinology, Hertzel Gerstein (McMaster University, Hamilton, Ontario, Canada) and co-authors write that their findings “reflect the beneficial vascular effects that were responsible for the reduction in cardiovascular outcomes, stroke, kidney disease, and cognitive impairments the REWIND study. “
“These beneficial effects include the effects of dulaglutide on glucose, systolic blood pressure and weight, as well as possible direct effects on small vessels and endothelial function,” they add.
The analysis included data from 3725 male REWIND participants (mean age 65.5 years) with type 2 diabetes who completed the standardized questionnaire on the International Index of Erectile Function at the start of the study and at least one follow-up examination (2 years, 5 years and end of the study) had. .
The men were randomly assigned to receive either dulaglutide or placebo for the duration of the study (up to 8 years). At baseline, 56.5% had moderate or severe erectile dysfunction (erectile function subscore ≤16) and 39.9% had a history of cardiovascular disease.
At follow-up, 73.8% of the men in the dulaglutide group and 75.7% of the men in the placebo group were found to have moderate or severe erectile dysfunction. This corresponded to a significantly 8% lower risk at dulaglutide and crude incidence rates of 21.3 and 22.0 cases per 100 person-years, respectively.
The researchers also report that after adjusting to baseline, men in the dulaglutide arm had less of a decrease in erectile function subscore than those in the placebo arm, with the score in the dulaglutide arm lower by an average of 0.61 points sank.
However, subgroup analyzes indicated that the reduced risk of moderate or severe erectile dysfunction may be limited to men with a history of cardiovascular disease. In this subgroup, the use of dulaglutide was associated with a significantly 19% lower risk compared to placebo, while there was no significant difference in risk between the two treatment arms in the men without CVD.
Gerstein et al .: “Clinical practice guidelines suggest that when selecting drugs to lower blood sugar, evidence for the prevention of diabetes-related chronic consequences should be considered.”
They are therefore of the opinion that their results “suggest that erectile dysfunction, which is a common consequence of type 2 diabetes in men, should be included in these considerations”.
In an accompanying comment, Sten Madsbad of Hvidovre Hospital in Copenhagen, Denmark says: “Although the finding was statistically significant in relation to the primary endpoint, the modest reduction in risk of 8% and the small absolute risk reduction plus the lack of an effect if Erectile dysfunction has been defined as more persistent erectile dysfunction that raises questions of clinical relevance across the study population. “
Nonetheless, he adds that the analysis provides “new and actionable information on the benefits of dulaglutide on the incidence of moderate or severe erectile dysfunction in men with type 2 diabetes, particularly those with cardiovascular disease”.
medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet Diabetes Endocrinol 2021; doi: 10.1016 / S2213-8587 (21) 00115-7
Lancet Diabetes Endocrinol 2021; doi: 10.1016 / S2213-8587 (21) 00142-X