The educational level impact on treatment adherence in PDE5i-naïve men with erectile dysfunction: A real-life cross-sectional study.

Introduction: The impact of the educational level on the adherence to phosphodiesterase type 5 inhibitors (PDE5i) among men with erectile dysfunction (ED) remains understudied. We aimed to investigate how the educational level influences patient's compliance to newly prescribed PDE5i in men with ED who had never previously used this class of drugs.

Materials and methods: Complete data from 1264 consecutive PDE5i naive men presenting with new onset ED were retrospectively analyzed. Patients were grouped according to their educational level into low (elementary and/or secondary school education), mid (high school), and high (university degrees) educational levels. Baseline health significant comorbidities were scored with the Charlson comorbidity index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the Beck depression inventory questionnaires at baseline. PDE5i were prescribed to all patients. Kaplan-Meier (KM) curves estimated the discontinuation free-survival (DFS) after stratification according to the educational level. Multivariable (MVA) Cox regression addressed the association between the educational level and PDE5is' discontinuation.

Results: Of all, 160 (13%), 573 (45%), and 531 (42%) individuals depicted low, mid, and high educational level, respectively. Median (IQR) age and follow-up time were 51 (39-61) and 8.5 (5.9-11.3) years, respectively. Patients with higher educational level were more likely to be younger (49 vs. 56 years, p < 0.001), reporting lower BMI values (25 vs. 26.3 kg/m², p < 0.001) and lower rates of CCI ≥ 1 (17% vs. 27%, p = 0.009), compared to their lower educational level counterparts. No significant differences were found in terms of duration of PDE5is assumption and IIEF-erectile function (IIEF-EF) across the groups. Kaplan-Meier survival analyses, stratified by the educational level, revealed significantly different patterns of PDE5i discontinuation-free survival across educational levels (log-rank test, p = 0.028). At multivariable Cox regression analysis, higher educational levels were significantly associated with PDE5i discontinuation, even after adjusting for age at presentation, IIEF-EF score, and relationship status simultaneously.

Conclusions: Current findings demonstrated that the higher the educational level, the greater the PDE5is discontinuation rate in men with ED. These results highlight a particular aspect of patients' compliance with PDE5is, enabling improvements in real-life pharmacological management for ED.