Association Between PDE-5 Inhibitor Therapy and the Hazard of Open-Angle Glaucoma.

Abstract

To evaluate the association between phosphodiesterase type-5 inhibitor (PDE-5i) therapy and the development of glaucoma suspect (GS) status or open-angle glaucoma (OAG) in men with erectile dysfunction (ED). Multicenter, retrospective cohort study using deidentified electronic health records. Male adults aged ≥ 40 years with ED, with or without chronic PDE-5i exposure. We used propensity score matching (PSM) to balance demographics, systemic and ophthalmic comorbidities, medications, laboratory measures. Additionally, we applied Cox proportional models on the unmatched cohorts to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Development of GS or OAG at 1, 2, and 3-years following PDE-5i exposure. Before matching, 40,676 men received PDE-5i therapy and 32,415 had no exposure. After PSM, the development of GS status was less frequent among PDE-5i users at 1 year (6.49% vs 9.73%, P < .01), 2 years (9.27% vs 10.86%, P < .01), and 3 years (11.17% vs 12.06%, P = .01). Similarly, the development of OAG was less frequent among PDE-5i users at 1 year (2.13% vs 3.22%, P < .01), 2 years (3.00% vs 3.80%, P < .01), and 3 years (3.88% vs 4.28%, P = .04). Cox proportional models demonstrated reduced hazards for GS at 1 year (aHR 0.78; 95% C: 0.75-0.81; P < .01), 2 years (0.89; 0.86-0.93; P < .01), and 3 years (0.94; 0.90-0.97; P = .01), and for OAG at 1 year (0.76; 0.71-0.81; P < .01), 2 years (0.79; 0.75-0.83; P < .01), and 3 years (0.84; 0.79-0.88; P = .01). Chronic PDE-5i use was associated with a lower hazard of developing GS and OAG over 1-, 2-, and 3-years of follow-up. These findings suggest a potential protective association between PDE-5i and glaucoma development that requires confirmation in prospective studies.