Glucagon-like receptor-1 agonists and impotence: A meta-analysis

Table 1 The effects of glucagon-like peptide receptors-1 agonists on erectile dysfunction

Ref.	Country	Age/years/GLP-1 agonists/control	BMI/GLP-1 agonists/control	Study type	Duration	GLP-1 type	Control	Score before	Score after	Number of patients/GLP-1 agonists/control
Defeudis et al[19]	Italy	64.1 ± 9.9 vs 62.3 ± 7.6	28.1 ± 3.6 vs 29.3 ± 5.6	Prospetive	48 months	GLP-1 agonists	Metformin	15.5 ± 5.7 vs 16.7 ± 4.7	-	20 vs 51
Giagull et al[20]	Italy	53.5 ± 4.4	34.2 ± 2.4	Retro.	12 months	Liraglutide	Cross-over	12 ± 2.2 vs 14.6 ± 1.7	14.6 ± 1.7 vs 19.9 ± 2	30 vs 16
Giagulli et al[21]	Italy	51.1 ± 2.9	33.5 ± 1.4	Retro.	12 months	Dulaglutide	Metformin	15.7 ± 1.7 vs 15.1 ± 1.1	18.0 ± 1.0 vs 19.1 ± 1.2	14 vs 14
Giagulli et al[21]	Italy	49.8 ± 2.9	34.0 ± 1.5	Retro	12 months	Liraglutide	Metformin	15.7 ± 1.7 vs 15.1 ± 1.1	15.1 ± 1.1 vs 18.7 ± 0.9	16 vs 16
La Vignera et al[22]	Italy	56.3 ± 4.7 vs 55.1 ± 5.2	35.3 ± 3.0 vs 34.6 ± 3.4	Pilot	8 weeks	Tirzepatide	Pilot	6.6 ± 1.5 vs 7.1 ± 1.25	8.8 ± 1.5 vs 7.3 ± 1.25	28 vs 30
Lengsfeld et al[23]	Switzerland	23.5 ± 4.15 vs 25 ± 3.25	24.1 ± 1.35 vs 23.2 ± 1.15	Trial	4 weeks	Dulaglutide	Placebo	9.8 ± 1 vs 10.4 ± 0.7	10.8 ± 2.6 vs 11 ± 1.9	12 vs 12
Lisco et al[24]	Italy	59 ± 4.5 vs 60 ± 3	34 ± 1.7 vs 33.7 ± 1.7	Retro.	12 months	Not specified	Metformin	15.3 ± 1.4 vs 15.7 ± 1.7	18.9 ± 1.2 vs 16.7 ± 1.5	63 vs 45

BMI: Body mass index; GLP-1 agonists: Glucagon-like peptide receptors-1 agonists.

Table 2 Testicular-pituitary hormones in the included studies

Ref.	TT before GLP-1 agonists	TT, after GLP-1 agonists	FT, before GLP-1 agonists	FT, after GLP-1 agonists	SHBG, before GLP-1 agonists	SHBG, after GLP-1 agonists	LH, before GLP-1 agonists	LH, after GLP-1 agonists	FSH, before GLP-1 agonists	FSH, GLP-1 agonists
Giagull et al[20]	430.8 ± 51.8	450.8 ± 42.4	7.95 ± 1.2	8.3 ± 0.95	37.7 ± 2.4	39.0 ± 1.6	Not assessed	Not assessed	Not assessed	Not assessed
Giagulli et al[21]	259 ± 12	310 ± 37	4.9 ± 0.3	5.6 ± 0.7	34.5 ± 2.20	39.4 ± 1.7	6.6 ± 0.8	6.8 ± 0.4	6.5 ± 0.8	6.8 ± 0.5
Giagulli et al[21]	262 ± 11	328 ± 33	5 ± 0.3	6 ± 0.6	34.6 ± 2.3	39 ± 1.8	6.2. ± 0.7	6.8 ± 2.8	6.6 ± 0.7	6.9 ± 0.5
La Vignera et al[22]	140 ± 60	410 ± 50	5.1 ± 0.64	Not assessed	14 ± 3	36 ± 4	2.3 ± 0.3	3.2 ± 0.2	1.6 ± 0.3	2.6 ± 0.2
Lengsfeld et al[23]	19.7 ± 2.9	20.4. ± 3.2	0.4 ± 0.1	0.4 ± 0.1	36.5 ± 9.69	40.6. ± 4.68	5.2 ± 1.48	4.5 ± 1	3.1 ± 1.83	3.1 ± 1.68
Lisco et al[24]	303.7 ± 41.7	337.7 ± 34.7	5.9 ± 1.3	6.6 ± 0.42	35.4 ± 2.1	39.4 ± 1.7	6.3 ± 0.8	6.8 ± 0.8	6.6 ± 0.7	6.9 ± 0.7

TT: Total; FT: Free testosterone; SHBG: Sex hormone binding globulins; LH: Luteinizing hormone; FSH: Follicular stimulating hormone; GLP-1 agonists: Glucagon-like peptide receptors-1 agonists.

Table 3 Newcastle-Ottawa scale risk of bias assessment tool

Ref.	Selection	Comparability	Outcome	Total score
Defeudis et al[19]	3	2	2	7
Giagull et al[20]	2	2	2	6
Giagulli et al[21]	4	2	2	8
Giagulli et al[21]	4	2	2	8
La Vignera et al[22]	2	2	2	6
Lengsfeld et al[23]	3	2	2	8
Lisco et al[24]	4	2	2	8

Table 4 Analysis of the quality of evidence by GRADE

Outcome	Studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	GRADE
ED	7	Trial = 1, retrospective = 4, pilot study = 1	Serious	Serious (I2 = 90%)	Not serious	Not serious	None	Very low
TT	6	Trial = 1, retrospective = 3, pilot study = 1	Serious	Serious (I2 = 99%)	Not serious	Not serious	None	Very low
FT	5	Trial = 1, retrospective = 3, pilot study = 1	Serious	Serious (I2 = 86%)	Not serious	Not serious	None	Very low
SHBG	6	Trial = 1, retrospective = 4, pilot study = 1	Serious	Serious (I2 = 99%)	Not serious	Not serious	None	Very low
LH	5	Trial = 1, retrospective = 3, pilot study = 1	Serious	Serious (I2 = 91%)	Not serious	Not serious	None	Very low
FSH	5	Trial = 1, retrospective = 3, pilot study = 1	Serious	Serious (I2 = 91%)	Not serious	Not serious	None	Very low

ED: Erectile dysfunction; TT: Total; FT: Free testosterone; SHBG: Sex hormone binding globulins; LH: Luteinizing hormone; FSH: Follicular stimulating hormone; GLP-1 agonists: Glucagon-like peptide receptors-1 agonists.