Intralesional Collagenase Injections - Peyronie's Treatment

Although Peyronie’s disease can be treated with oral medication, it has been found that these offer poor vascularisation of the plaque in the chronic phase, meaning that less of the drug reaches the area of interest. For this reason, at Andrology Barcelona we opt for intralesional drug injections, which offer higher concentrations of the drug in the plaque and have few systemic adverse effects.

As experts in the treatment of Peyronie’s disease in Barcelona, we recommend the use of Clostridium hystolyticum collagenase, as it is the only drug specifically approved for this use.

Clostridium histolyticum Collagenase Injections

Clostridium hystolyticum collagenase (Xiapex®) is a purified bacterial enzyme that selectively attacks collagen in fibrotic plaque. It was first used in the treatment of Dupuytren’s disease, and in 2013, the Food and Drug Administration (FDA) approved its use for Peyronie’s disease. Subsequently, in 2015, the European Medicines Agency (EMA) approved the use of CCH for the chronic phase of Peyronie’s disease in patients with palpable plaque, without septal involvement, and with dorsal or dorsolateral curvatures between 30º and 90º.

Unfortunately, this drug (Xiapex®) is not currently available in Europe, as the pharmaceutical company that marketed it has withdrawn its distribution on our continent.

Effectiveness of collagenase versus placebo

In a phase 2b study conducted on patients with stable Peyronie’s disease, treatment with 6 intralesional injections of 0.58 mg of CCH collagenase reduced penile curvature by 29.7% at 36 weeks, compared to a reduction of 11% in the placebo group (p=0.001). This improvement in curvature was also accompanied by a significant improvement in symptoms. When comparing subgroups of patients who performed penile modeling, those treated with CCH showed an improvement of 32.4%, while those treated with placebo experienced a worsening of 2.5% in the plaque.

How is the treatment carried out?

Originally, 4 cycles of 2 injections (administered 24-72 hours apart) of 0.58 mg of CCH collagenase with penile modeling were performed. Due to the high cost of the treatment, protocols have been developed to reduce the drug dosage and increase its efficacy by combining it with traction devices or vacuum devices.

Additionally, during treatment, it is recommended to avoid sexual activity for the first 4-6 weeks after the injection of CCH.

Does it have side effects?

As a result of the use of intralesional injections, 50% of patients experienced bruising at the injection site, 33.5% reported pain, 28.9% swelling, and 24.1% hypersensitivity at the injection site. Additionally, corporal fractures were observed in only 0.9% of cases.

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