(034) COMPARATIVE OUTCOMES OF PHOSPHODIESTERASE 5 INHIBITORS AND COLLAGENASE CLOSTRIDIUM HISTOLYTICUM VS. COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ALONE FOR MANAGEMENT OF PEYRONIE’S DISEASE: A MULTICENTER RETROSPECTIVE CHART REVIEW
Authors: Angulo-Llanos L , Garrett GM , Sandler MD , Tran DV , Saffati Grunhaus G , Orozco Rendon D , Hinojosa-Gonzalez DE , Kronstedt S , Miller JA , Moukhtar Hammad MA , Yafi FA , Khera M , Raheem O , Masterson TA 
Published: December 2024

Abstract

Introduction
Collagenase C. histolyticum (CCH) is currently the only intralesional medication approved by the Food and Drug Administration for Peyronie’s disease (PD), effectively reducing penile curvature through the digestion of collagen. Phosphodiesterase 5 inhibitors (PDE5i) have demonstrated antifibrotic effects by decreasing collagen deposits, profibrotic factors, oxidative stress, and myofibroblast count. However, the clinical application of PDE5i for PD remains unclear.

Objective
To date, there are no large, multi-institutional studies assessing the long-term outcomes of CCH in combination with PDE5i for PD. This study aims to determine outcomes in reducing penile curvature and side effects when combining PDE5i with CCH for PD.

Methods
We conducted multi-institutional retrospective chart review on men aged ≥18 who underwent CCH for PD between January 1, 2013, and December 31, 2023. Data collection consisted of patient demographics, erectile dysfunction diagnosis, medications (including PDE5i), baseline penile Doppler ultrasound, pain and International Index of Erectile Function (IIEF) scores, as well as treatment protocols. Patients were categorized into two groups: those treated with PDE5i and CCH (Group A), and those treated with CCH alone (Group B). Outcomes were assessed by changes in penile curvature, pain reduction, improvement in IIEF scores, patient satisfaction, and incidence of adverse events. Statistical analysis was performed to compare the efficacy and safety between the two treatment groups, with significance set at a p-value of &lt;0.05. Additionally, we reviewed how frequently PDE5i is prescribed for PD.

Results
Of the 574 patients, the mean pre-treatment curvature for both groups was 45.9 degrees (Table 1). There was no significant difference in curvature improvement between Group A and Group B (15.9% for Group A and 16.7% for Group B). Patient-reported subjective improvement was 40% in both groups, and there was no difference in incidence of adverse events. 5 patients from each group experienced a penile fracture following CCH injection (Table 2). Additionally, PDE5i was only prescribed if patients reported erectile dysfunction and is not typically combined with CCH as a standard of care.

Conclusions
The combination of PDE5i with CCH does not appear to improve outcomes compared to CCH alone in men with PD. Both groups exhibited comparable curvature improvements and subjective outcomes. Additionally, incidence of adverse events, including penile fractures, was similar between groups, indicating that the use of PDE5 inhibitors does not affect the safety profile of CCH.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endopharmaceuticals.