Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder.
Spielmans. Glen I GI; Ellefson. Elaine M EM
Key Findings
- Commonly used sexual function scales (FSFI, FSDS-DAO) have weak validity for women with hypoactive sexual desire disorder.
- When the unpublished trial data were examined, effect sizes for bremelanotide ranged from none to small.
- Most reported benefits appear to come from post‑hoc analyses rather than pre‑planned, validated outcomes.
Practical Outcomes
- For biohackers, the take‑away is that pt‑141 does not have strong, reliable evidence of benefit for low sexual desire in women, and the measurement tools used are questionable. It’s not a high‑priority supplement to try for this purpose, and any small effects are likely not clinically meaningful.
Summary
The study looked at how well the usual questionnaires measure the benefits of bremelanotide (pt-141) for women with low sexual desire. It found that many of the scores used aren’t proven to be reliable for this condition, and the drug only showed tiny or no improvements on most of the outcomes.
Abstract
Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.
Study Information
pubmed
2023
2023-02-21T00:00:00.000Z
10.1080/00224499.2023.2175192
2
129