Review of Management Options for Active-Phase Peyronie's Disease - Beyond the Abstract

The treatment of active-phase Peyronie’s Disease (PD) focuses on both decreasing curvature and managing pain. Although surgery is the standard treatment once the curvature has stabilized for more than one year, known as the stable phase of PD, clinicians have sought more options for their patients. Currently, oral therapies have proven mostly ineffective, excluding a placebo effect. 

Extracorporeal shock wave therapy (ESWT) may help patients recover from pain more rapidly than the natural progression of the disease; however, because it does not lead to better curvature outcomes, it is not recommended as a solo treatment of PD.1

Currently, the most popular choice among physicians for the minimally invasive treatment of stable PD is intralesional injections of collagenase Clostridium histolyticum (CCH). More recent evidence implicates CCH as a favorable option for the active phase. Nguyen, et al. reported that, CCH can be safe and effective in the treatment of active phase PD.2 However, as CCH for the active phase treatment is not yet US Food and Drug Administration-approved, it is also not reimbursable through insurance; therefore, costs can be exorbitant.3

Another possible active-phase PD treatment is that of intralesional injections of Interferon-α2b (IFN-α2b), which has shown positive results similar to that of CCH, and has been designated by the European Association of Urology as a potentially effective therapy.4

The research regarding treatment options for the active phase of PD is rapidly changing. Presently, intralesional injections of CCH is one of the most popular options chosen by urologists for the treatment of stable phase PD and the evidence for its use in the active phase is increasing.5 Other therapies such as oral, topical creams, and ESWT remain alternative options for the wide range of patients physicians will treat.

Written by: Scott Brimley, BS, Faysal A. Yafi, MD, FRCSC, Wayne J.G. Hellstrom, MD, Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana 

References:
1. Chung E, Ralph D, Kagioglu A, Garaffa G, Shamsodini A, Bivalacqua T, et al. Evidence-Based Management Guidelines on Peyronie's Disease. J Sex Med. 2016;13(6):905-23.
2. Nguyen HMT, Anaissie J, DeLay KJ, Yafi FA, Sikka SC, Hellstrom WJG. Safety and Efficacy of Collagenase Clostridium histolyticum in the Treatment of Acute-Phase Peyronie's Disease. J Sex Med. 2017;14(10):1220-5.
3. Kuhlmann PK, DeLay KJ, Anaissie J, Hellstrom WJ, Yafi FA. Collagenase. Patient Prefer Adherence. 2017;11:431-48.
4. Sokhal AK, Jain NK, Jhanwar A, Singh K, Saini DK. Prospective study to evaluate the clinical outcome of intralesional interferon-α2b in the management of Peyronie's disease. Urol Ann. 2018;10(2):154-8.
5. Gabrielson AT, Spitz JT, Hellstrom WJG. Collagenase Clostridium Histolyticum in the Treatment of Urologic Disease: Current and Future Impact. Sex Med Rev. 2018;6(1):143-56.

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