SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Ethnopharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1537789
Compound Xuanju capsules combined with phosphodiesterase-5 inhibitors as a new strategy for erectile dysfunction: a meta-analysis and trial sequential analysis
Provisionally accepted- 1School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Anhui Province, China
- 2The Second Hospital of Hunan University of Chinese Medicine, Changsha, Anhui Province, China
- 3Hunan University of Medicine, Huaihua, Hunan Province, China
- 4School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan Province, China
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Objective: The efficacy of compound Xuanju capsule (CXC) in the treatment of erectile dysfunction (ED) remains unclear. This study aimed to quantitatively assess the benefits and risks of CXC in the treatment of ED. Methods: Eight major databases were systematically searched for relevant literature published till May 10, 2025. Studies were screened based on established criteria; meta-analysis and trial sequential analysis of included literature were conducted.Results: The meta-analysis demonstrated that, compared with phosphodiesterase type 5 inhibitors alone, the combination of CXC and phosphodiesterase type 5 inhibitors significantly improved the International Index of Erectile Function (IIEF)-5 score by 3.19 points (mean difference [MD] = 3.19; 95% confidence interval [CI]: 2.42–3.96; P < 0.00001), clinical effectiveness rate by 23% (risk ratio [RR] = 1.23; 95% CI: 1.15–1.32; P < 0.00001), penile cavernous blood flow by 5.21 cm/s (MD = 5.21; 95% CI: 4.43–6.00; P < 0.00001), and serum testosterone levels by 4.09 nmol/L (MD = 4.09; 95% CI: 3.14–5.04; P < 0.00001). There was no significant difference in total adverse events between the groups (RR = 0.94; 95% CI: 0.62–1.42; P = 0.77). Trial sequential analysis confirmed that the meta-analysis results for IIEF-5, clinical effectiveness rate, penile cavernous blood flow, and serum testosterone levels were conclusive. However, the results of adverse events require further validation through additional similar studies. Funnel plot analysis and Egger’s test indicated no potential publication bias for outcomes other than the clinical effectiveness rate.Conclusion: CXC improves erectile function and testosterone levels in patients with ED without increasing the incidence of adverse events. These findings support the potential role of CXC as an adjunctive treatment for ED. However, due to the limitations in the quality of the current evidence, further validation through multicenter, randomized, double-blind controlled trials is necessary.
Keywords: Compound Xuanju Capsule, phosphodiesterase type 5 inhibitor, Erectile Dysfunction, Meta-analysis, Trial sequential analysis
Received: 01 Dec 2024; Accepted: 04 Jun 2025.
Copyright: © 2025 Li, Yu, Guo, Yu, He and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Qinghu He, School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Anhui Province, China
Guomin Zhang, School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.