The ranking that put 25mg on top is the method talking
Across 179 trials and 50,620 men, a ranking gave 25mg of sildenafil a 98% probability of being the best single option, built from trials that never compared these doses.
What the study found
A 179-trial ranking put sildenafil 25mg above 50mg and 100mg
Every oral drug in this class beat placebo across 179 randomised trials and 50,620 men. The ranking built on top of that gave 25mg of sildenafil a 98% probability of being the best single option, ahead of 50mg and 100mg. That is almost certainly the ranking method talking, not the dose.
The caveat · Doses never tested head to head
The ranking comes from indirect comparison across trials that never tested these doses against each other, which is far less stable than head-to-head data. Read as advice for one man choosing a dose, it means nothing. Most of the trials underneath it were short and manufacturer-funded.
What we don't know
The ranking comes from indirect comparison across trials that never tested these doses against each other, which is far less stable than head-to-head data. Read as advice for one man choosing a dose, it means nothing. Most of the trials underneath it were short and manufacturer-funded.