Can We Predict Curve Improvement in Men With Peyronie’s Disease Receiving Xiaflex?

Peyronie’s disease (PD) is a medical condition that causes penile curvature. According to some estimates, it affects between 1 to 11% of men in their lifetime, usually presenting when a man is between 50 to 60 years old.

The characteristic penile curve of PD is caused by plaques or scar tissue beneath the skin of the penis, causing it to bend or take on other deformities in shape (e.g., an hourglass deformity). Depending on the severity of the curve or penile deformity, the individual may or may not be able to perform penetrative sex.

PD occurs in two phases: the acute phase and the chronic phase. During the acute phase, scar tissue forms on the penis, resulting in changes in penile shape or length and occasionally painful erections. After 3 to 6 months without further changes in the penis, a person is considered to be in the chronic phase of PD.

One treatment option for PD is collagenase clostridium histolyticum (commercially known as Xiaflex), a medication that is injected into the penis to decompose components of the PD plaques. This treatment is carried out over two to four cycles with two injections per cycle.

To determine if specific factors make this treatment more or less effective, the authors of a recent study examined the data of 114 patients who received up to eight injections over four cycles between January 2014 and July 2020. The median age of the participants was 57 years, and the average penile curvature at baseline was 47 degrees. After treatment, the average penile curvature was 40 degrees.

Of all the individuals included in this study, 44% saw an improvement in their curvature after treatment, 39% had no change, and 17% worsened after treatment. Interestingly, the men with the greatest baseline penile curvature saw the greatest degree of improvement from this therapy.

Baseline Penile Curvature        Percentage of Men Who Saw Curve Improvement

≤30 degrees                             29%

31-50 degrees                          40%

51-60 degrees                          50%

≥60 degrees                             60%

These figures suggest that penile curvature improvement after Xiaflex injections was significantly more common in the individuals who had a greater baseline penile curvature. This is helpful information for PD patients who are considering this treatment.

References:   

Flores, J.M., Nascimento, B., Punjani, N., Salter, C.A., Bernie, H.L., Taniguchi, H., Miranda, E., Terrier, J.E., Schofield, E., Jenkins, L., & Mulhall, J.P. (2022). Predictors of Curvature Improvement in Men With Peyronie's Disease Treated With Intralesional Collagenase Clostridium Histolyticum. The Journal of Sexual Medicine, 19(11), 1680-1686. DOI: https://doi.org/10.1016/j.jsxm.2022.08.001