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The use of sildenafil was shown to be more efficacious than apomorphine in improving (i.e.,
increasing) IIEF scores for “erectile function” as well as for other domains (e.g. “intercourse
satisfaction,” “overall satisfaction”). 117,148,159 For example, the mean IIEF score values for the
“EF” domain in patients who received sildenafil and apomorphine were 25.2 (95 percent CI:
23.7–26.7) and 15.9 (95 percent CI: 14.4–17.3), respectively, with a mean difference of 9.3 (95
percent CI: 7.6–11.1) between the two groups. 117 In the other trial, 159 the corresponding least
square mean values for the IIEF “EF” domain were 23.1 (95 percent CI: 21.8–24.4) and 15.7
(14.5–17.0), with a mean difference of 7.2 (95 percent CI: 5.5–8.8).
The proportions of patients who answered “yes” to questions 1 and 2 of GAQ (Question 1:
“Compared with having no treatment at all for your erection problem, has the medication you
have been taking over the past 4 weeks improved your erections?”; Question 2: “Compared with
having no treatment at all for your erection problem, has the medication you have been taking
over the past 4 weeks improved your ability to have sexual intercourse?”) were numerically
higher in the sildenafil group than in the apomorphine group (94.8 and 93.9 percent versus 51.7
percent and 48.7 percent, respectively). 117 Similarly, in the other trial, 159 statistically significant
differences were observed between patients receiving sildenafil and apomorphine with respect to
GAQ–Q1 (88.7 percent versus 43.1 percent, p < 0.0001).
In the same trials, 117,159 the mean EDITS scores for patient satisfaction were higher in
patients receiving sildenafil (82.5 and 74.0, respectively) compared with those receiving
apomorphine (46.8 and 47.0, respectively).
According to results obtained from two trials, 117,120 more patients preferred sildenafil than
apomorphine. The percent of patients who preferred sildenafil over apomorphine across these
trials ranged from 65.1 percent 120 to 96.6 percent. 117 In contrast, the percentage of patients who
preferred apomorphine over sildenafil ranged from 2.3 percent 120 to 3.4 percent. 117
Apomorphine (combined with phentolamine and/or papaverine) versus sildenafil.
Harms. In this trial, 251 the overall rates of adverse events in apomorphine combined with
papaverine and phentolamine (APP), a combination of phentolamine and papaverine, and a
combination of apomorphine and phentolamine, and sildenafil were 25.0, 19.1, 17.1, and 15.0
percent, respectively. Only one patient developed a serious adverse event (i.e., right
nephrectomy) in the APP arm. The most frequently reported adverse events in this trial were
rhinitis (4.8–15 percent) and headache (2.4–5.0 percent), the highest percentages observed in the
APP arm. The authors of this trial did not report the proportion of patients in each arm that
withdrew due to adverse events.
Efficacy. One trial, 251 found no significant differences (one-tailed p >0.05) between the
combined apomorphine (either with phentolamine or phentolamine and papaverine) and
sildenafil arms for most of the outcomes (e.g. mean SEP VAS rigidity, duration, and satisfaction
scores, proportion of successful vaginal penetration, and mean satisfaction score based on GAQ
scale).
Quantitative Synthesis - Meta-analysis of Trials
Apomorphine mono versus placebo. Five trials 248-250,252,253 were considered to be eligible
for meta-analysis. However, no meta-analysis could be performed because numerical
information was lacking such as standard deviations (or standard errors) 248-253 , pre-crossover data
252 , mean values 253 for percent successful intercourse attempts and the IIEF-EF domain.
Apomorphine versus sildenafil. Trials (all crossover design) comparing the efficacy and
safety profiles of apomorphine and sildenafil were not meta-analyzed because of clinical
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