Collagenase Clostridium Histolyticum: A Review in Peyronie’s Disease

Abstract

Collagenase Clostridium Histolyticum (CCH) (Xiaflex(®), Xiapex(®)) intralesional injection is a mixture of class I (AUX-I) and class II (AUX-II) clostridial collagenases. It is indicated for the treatment of adult men with Peyronie's disease with a palpable plaque and curvature deformity of ≥ 30° at the start of therapy. This article reviews the efficacy and tolerability of CCH in this indication and briefly summarizes its pharmacology. CCH treatment significantly improved penile curvature deformity and reduced patient-reported bother associated with Peyronie's disease in the 52-week, double-blind, phase III IMPRESS I and II studies. Treatment benefit with CCH was also seen in 36-week, open-label studies, providing further support for its efficacy. CCH was generally well tolerated in patients with Peyronie's disease, with most treatment-related adverse events being of mild or moderate severity. Serious treatment-related adverse events (penile haematoma or corporal ruptures) were reported in <1% of CCH recipients in clinical studies. Although further studies assessing the long-term effects of CCH intralesional injection are needed, current evidence indicates that this is a minimally invasive, effective and generally well tolerated treatment option for patients with Peyronie's disease.

Intralesional collagenase Clostridium histolyticum in the management of Peyronie’s disease: current best practice

“…26 These enzymes manifest their effects through hydrolysis of types I and III collagen fibers (found in bone, connective tissue, scar, and PD plaques) while sparing collagen type IV (found in vascular and nervous tissues). 22–26 Ex vivo studies have confirmed that each form of collagenase cleaves collagen fibers at a different site, leading to the synergistic effect of CCH. 25…”

“…22–26 Ex vivo studies have confirmed that each form of collagenase cleaves collagen fibers at a different site, leading to the synergistic effect of CCH. 25…”

“…22 Initially isolated in the mid 1950s, CCH was first described showing effectiveness in PD by Gelbard and colleagues in 1982. [22][23][24][25] CCH consists of two isoforms of collagenase, AUX-I and AUX-II, contained in a phosphate buffer. 26 These enzymes manifest their effects through hydrolysis of types I and III collagen fibers (found in bone, connective tissue, scar, and PD plaques) while sparing collagen type IV (found in vascular and nervous tissues).…”

The efficacy and safety of intralesional injection of collagenase Clostridium histolyticum for Peyronie’s disease: A meta-analysis of published prospective studies

“…The prevalence of PD is reportedly from 22.4 to 25.7 per 100,000 men, and the average age of patients is 55 years (Herati and Pastuszak, 2016). Actually, the incidence of PD might be underestimated due to under-reporting bias from those patients who are reluctant to visit hospitals (Dhillon, 2015).…”

“…The prevalence of PD is reportedly from 22.4 to 25.7 per 100,000 men, and the average age of patients is 55 years ( Herati and Pastuszak, 2016 ). Actually, the incidence of PD might be underestimated due to under-reporting bias from those patients who are reluctant to visit hospitals ( Dhillon, 2015 ). As of yet, surgery is considered the gold-standard treatment of PD in the stable phase to provide patients with permanent functional recovery and correction of penile deformity ( Wymer et al, 2019 ).…”