Penile surgery for patients with Peyronie’s disease initially treated with collagenase clostridium histolyticum or surgery: a claims database analysis

Abstract

Collagenase clostridium histolyticum (CCH) is an injectable therapy targeting collagen present in penile plaques in Peyronie’s disease (PD). Data comparing CCH to penile surgery are limited, and long-term therapeutic outcomes are unknown. This retrospective analysis used a US claims database (January 2014–June 2017) to determine the percentage of men with subsequent penile surgery among those who initially received CCH (n = 1227) or surgery (index treatment; n = 620) for PD. Eligible patients were aged ≥18 years with continuous enrollment ≥6 months before and ≥12 months after index treatment date. During 12 months of post-index treatment follow-up, fewer patients with PD initially treated with CCH (4.6% [56/1227]) had subsequent penile surgery versus those initially treated with penile surgery (10.3% [64/620]; p < 0.0001). Mean ± SD time to first subsequent surgery after initial PD treatment was longer in the CCH versus surgery cohort (7.7 ± 3.0 vs 1.7 ± 3.2 months). The likelihood of subsequent surgery varied by initial surgery type: 18.2% after plaque incision or excision with grafting; 11.6% after penile implant; and 8.2% after tunical plication. Patients with PD who received CCH first were less likely to undergo subsequent surgery compared with those who received surgery first within a 12-month post-treatment follow-up.

Reply: Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie's Disease: A Randomized Trial

“…These advantages may mitigate the cost of treatment of complications and further treatment of functional side effects as well as translate to lower out-of-pocket costs to patients. 5 We can see, however, where legitimate concern exists in the realm of focal therapy, a large umbrella term encompassing multiple energy/ablative modalities employed in the management of intermediate-risk prostate cancer. This nascent field of prostate cancer therapy is still under evaluation and there exists a large heterogeneity in the techniques, study design, and patient selection.…”

“…Indeed, the published literature confirms that both in the US and throughout the world, using insurance databases or urologist logs, and whether examining a generalist or specialist, plications are performed several-fold more frequently than I&G/PEG. 5-7 Temporal trends have also demonstrated a > 3-fold shift from I&G/PEG to plication from 2004 to 2013. 7 All of these data would suggest that the current study is consistent with contemporary practice and national/international reports.…”

Reply: Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie’s Disease: A Randomized Trial

“…In this manner, the study is more reflective of actual clinical practice and is also consistent with practice patterns throughout the United States. 3 It is notable that although the majority of men received the “lower” side effect procedure (ie, plication), the adverse event rates were still higher than those in the collagenase Clostridium histolyticum arm. Had the patient selection been reversed (ie, higher rate of incision/excision and grafting procedures), the study would have likely opened itself to more (not less) criticism that procedural selection accounted for the differences observed.…”