Madeira CR, Tonin FS, Fachi MM, et al. - This research was sought to evaluate the benefit–risk ratio on the efficacy and safety of all phosphodiesterase type 5 inhibitors (PDE5i) in men with erectile dysfunction. Researchers conducted a systematic review with network meta-analysis, surface under the cumulative ranking analysis and stochastic multicriteria acceptability analyses. They carried out to search of Pubmed, Scopus, Web of Science without limits for time-frame or language. They included randomized controlled trials assessing the efficacy or safety of any PDE5i compared to a placebo or to other PDE5i in males with erectile disfunction. This study included 184 articles representing 179 randomized controlled trials including a total of 50,620 patients. The results considered that sildenafil at low doses and tadalafil should be the first therapeutic options. It was shown that avanafil, lodenafil and mirodenafil use are hardly justified given the lack of expressive efficacy or high rates of adverse events.