Future concepts and therapy approaches for Peyronie’s disease

ABSTRACT

Introduction

Collagenase Clostridium histolyticum (CCh) is the only drug approved by the US Food and Drug Administration for the treatment of Peyronie’s Disease (PD). However, it is limited in its scope of approval as well as its access for use internationally.

Areas covered

This review discusses the evidence on the expanded use of CCh for acute and atypical PD as well as novel, non-surgical treatment options that have been investigated since the FDA first approved of CCh. The PubMed database was thoroughly reviewed in the English-language for abstracts published between January 2013 to May 2020 using the keywords Peyronie’s disease, treatments, and therapy. A total of 90 unique articles were found to be relevant to the conservative management of PD. After excluding redundant articles, 39 manuscripts were given full review and included in this study, representing 2,807 patients with PD.

Expert opinion

Until definitive treatment becomes available, combinations of differing modalities may be the most viable option in addressing the unique concerns for each patient. Furthermore, the literature available varies widely in quality. There is a need for systematic definitions of the disease process as well as identifying treatment benchmarks that would maximize the patient quality of life.

KEYWORDS:

• Acute Peyronie’s disease
• atypical Peyronie’s disease
• electromotive drug administration
• extracorporeal shock wave therapy
• intralesional therapy
• iontophoresis
• nonsurgical therapy
• penile traction
• Peyronie’s disease
• stem cells

Article highlights

• Collagenase Clostridium histolyticum (CCh) was the first and only drug approved by the US Food and Drug Administration (FDA) for Peyronie’s Disease (PD) in 2013. Since its initial approval, studies have demonstrated CCh’s safety and efficacy in patients considered to be ‘off-label,’ including acute phase and atypical PD.

• CCh was withdrawn from the European Union in 2019, extending its unavailability in the international markets. Without access to CCh, patients worldwide are confronted with the difficult decision to pursue alternatives with less than desirable ratings by major governing urologic societies or undergo invasive operations.

• Since 2013, novel, non-surgical treatment options have been investigated with some promise, including intralesional, mechanical, and topical modalities. Animal studies continue to elucidate possible molecular and genetic targets for PD therapy but are still in its infancy.

• One modality will unlikely treat all major aspects of PD including penile curvature, pain, and sexual dysfunction. Until definitive treatment becomes available for the conservative management of PD, emphasis must be made in offering a combination of therapies to address the greatest concerns unique to each patient.

• The literature available varies widely in its reporting and study design. There is a need for standardization in the definition of disease characteristics (e.g., atypical features), the formation of study designs, and identification of treatment benchmarks proven to impact patient’s quality of life.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.