New research in the Journal of Sexual Medicine reports that injections of collagenase Clostridium histolyticum (CCH) can be a safe and effective way to treat Peyronie’s disease in its acute phase.
Peyronie’s disease is characterized by fibrous plaques that form in the tunica albuginea, just beneath the skin of the penis. These plaques cause the penis to lose some of its flexibility, leading to a distinct curvature that makes intercourse difficult for both men and their partners. Some men with Peyronie’s disease experience pain, erectile dysfunction, depression, and anxiety.
There are two clinical stages of Peyronie’s disease. During the acute phase, plaques form and curvature progresses. Men who feel pain usually so during this phase, which can last for up to two years.
Once symptoms have stabilized for at least three months, men are in the stable phase of Peyronie’s disease.
CCH injections have been approved for the treatment of stable-phase Peyronie’s disease, but there has been limited research on its efficacy and safety for men in the acute phase. The current study explored this further.
Researchers collected retrospective data from 162 men – 36 in the acute phase (Group 1) and 126 in the stable phase (Group 2). On average, the men were in their early-to-mid fifties. Group 1 had had Peyronie’s disease for an average of 8.5 months. For Group 2, the average duration was 18 months.
A variety of assessment techniques were used, including penile curvature measurements, stretched penile length, and evaluation of adverse events. Sexual function was assessed using the International Index of Erectile Function (IIEF) questionnaire.
Baseline curvature was similar for both groups – 60.6 degrees for Group 1 and 56.9 degrees for Group 2. Erectile function based on IIEF scores was also similar.
A CCH treatment cycle consisted of two intralesional injections to the flaccid penis spaced 24 to 72 hours apart. Cycles were repeated every six weeks; most patients received four cycles of treatment.
After treatment, 80.6% of the men in the acute phase had improvements in curvature, and almost 14% had the same curvature as before. For the men in the stable phase, 84.1% had decreased curvature and 15.1% had no changes. Overall, mean changes in curvature, IIEF scores, and stretched penile length were similar for both groups.
In addition, there were no significant differences in treatment-related adverse effects between the groups. Roughly 90% of the men overall had no side effects. Hematoma affected 5% of Group 1 and 7% of Group 2.
The authors explained that CCH might prevent plaque formation, which could be the reason it worked well for men in the acute phase. “By cleaving collagen while it is simultaneously accumulating in the tunica albuginea, CCH therapy during the acute phase can actually prevent the formation of dense calcified plaques that will ultimately become harder to treat,” they wrote.
They added that their findings on safety suggest “that CCH therapy in the acute phase might be just as safe to use as it is in the currently approved stable phase” and recommended further research to confirm their results.
The Journal of Sexual Medicine
Nguyen, Hoang Minh Tue, BA, et al.
“Safety and Efficacy of Collagenase Clostridium histolyticum in the Treatment of Acute-Phase Peyronie’s Disease”
(Full-text. Published online: September 2, 2017)