OBJECTIVE: To compare the efficacy and safety between different dosages of 
avanafil for the treatment of erectile dysfunction (ED).
METHODS: PubMed, Cochrane Library, and Embase were searched to identify 
randomized controlled trials which compared avanafil with placebo, or compared 
different dosages of avanafil for ED. International Index of Erectile 
Function-Erectile Function domain score (IIEF-EF), Sexual Encounter Profile 
Question (SEP) questions 2 and 3, and adverse events were considered as the 
study outcomes. Both pairwise meta-analysis and network meta-analysis were 
carried out.
RESULTS: Five studies including 2225 patients were assessed. The pairwise 
meta-analysis suggested that avanafil was more effective than placebo in 
improving IIEF-EF (mean difference [MD]: 4.47; 95% confidence interval [CI]: 
3.51 to 5.43), SEP-2 (MD: 17.41; 95% CI: 14.03 to 20.79), and SEP-3 (MD: 20.01; 
95% CI: 22.98 to 37.22), with an evident dose-response relationship. The 
effectiveness was significantly different between the 50 mg and 100 mg groups, 
or between the 50 mg and 200 mg groups, for all outcomes. Overall, avanafil was 
associated with a significantly higher incidence of any adverse event (risk 
ratio [RR]: 2.56; 95% CI: 1.66 to 3.94), serious adverse event (RR: 2.78; 95% 
CI: 1.34 to 5.76), flushing (RR: 6.06; 95% CI: 3.37 to 10.88) and headache (RR: 
7.54; 95% CI: 3.52 to 16.12) when compared with placebo. No significant 
difference in safety was found among various dosage groups.
CONCLUSIONS: Avanafil, from 50 to 200 mg, is effective and well tolerated for 
the treatment of ED, and an increase in dosage is associated with a significant 
rise in effectiveness but not with significantly more adverse events.