Obesity Clinical Trial
Official title:
Effects of Daily Tadalafil on Body Composition in Men With Sexual Distress
Data confirming a role for PDE5 in adipocyte biology in vitro have been recently reported.
However, a better understanding of the complex role of PDE5 in fat metabolism and whole body
homeostasis requires the use of transgenic animal models either lacking or overexpressing
PDE5 in adipose tissue. This will clarify the role of PDE5 in adipose expansion and
metabolism, and also in glucose homeostasis and vascular function in vivo. Analysis of
expression and activity of PDE5 in different sites of human adipose tissue (i.e. visceral vs.
subcutaneous), and also in different metabolic conditions (i.e. high-fat diet vs. low calorie
intake) could reveal if PDE5 can be considered to be a reliable 'marker' of metabolic
dysfunction of the adipocyte. Importantly, chronic treatment with the PDE5 inhibitor
sildenafil in a mouse model of diet-induced insulin resistance caused a significant
improvement in insulin sensitivity . Also, in humans chronic exposure to tadalafil confirmed
an improvement of insulin sensitivity in men with erectile dysfunction. However, the efficacy
of long-term treatment with PDE5i awaits demonstration in human metabolic diseases such as
obesity and insulin resistance.
The primary purpose of the study is to investigate the effects of tadalafil taken once a day
on body composition in men with sexual distress and/or erectile dysfunction.
Study design: open-label, randomized controlled study Study duration: 16 weeks (8 active
treatment + 8 follow-up)
At baseline, after 8 and 16 weeks the following evaluations will be assessed: general
physical examination and anthropometric parameters i.e., body weight (BW), height, BMI, and
waist circumference (WC). Every eight weeks, body composition was calculated by using a whole
body dual-energy X-ray absorptiometry (DEXA-HOLOGIC QDR-1000) according to the instructions
of the manufacturer and standardized procedures, and the individual Total Fat Mass (FM)
variation has been expressed as delta-variation (%) from baseline. Abdominal fat mass
(distrectual, described as R1) was calculated by using arbitrary area of the square chosen by
tracing of an ideal line joining last inferior ribs and anterior superior iliac spines.
Calibration with the manufacturer's spine phantom and quality control analysis were performed
daily. Fat Mass was expressed in grams per square centimeter (g/cm2) and result expressed as
variation in percentage. Secondary outcomes were variations forom baseline of IIEF-5, total
testosterone, estradiol and testosterone /estradiol ratios.
STATISTICAL EVALUATION With a two-sided alpha value of 5% and power of 90%, a sample size of
20 subjects per arm would be able to detect a 2% variation in the percentage of body lean and
fat mass from the baseline at upper waist section (for fat mass) and overall body composition
(for lean mass). Also, we tested for the differences between treatment groups by using
analysis of variance for repeated measures. Statistical analysis was performed by using the
computer statistical package SPSS 11.0 (SPSS Inc., Chicago, IL).
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