(118) Clinical Predictors of Long-Term Satisfaction with Treatment of Collagenase Clostridium Histolyticum for Patients with Peyronie’s Disease
Authors: Song J , Dai M , Naeem T , Saffati G , Khera M , Lipshultz L 
Published: February 2024

Abstract

Introduction
Collagenase clostridium histolyticum (CCH) is the only FDA-approved medication for Peyronie’s Disease (PD) in the United States. Roughly half of patients who received CCH experience improvements in curvature by more than 20% in the IMPRESS I/II trials. Current literature reports varying satisfaction rates of 67-81% within one year of treatment completion. However, little is known of long-term patient satisfaction following CCH treatment and its clinical predictors.

Objective
The aim of this study was to identify clinical predictors of long-term satisfaction with CCH for PD.

Methods
An Institutional Review Board approved retrospective chart review and standardized questionnaire was conducted for all patients with PD who received CCH from 2009-2022. Patients who received CCH before presenting to our institution were excluded. The questionnaire utilized the Treatment Satisfaction Questionnaire for Medication (TSQM), which is validated across the subdomains of satisfaction with effectiveness, side effects (SE), convenience, and global satisfaction (GS), and summed to generate the TSQM total score. Statistical analyses were performed in R using Wilcoxon rank sum test and independent T-test to compare continuous variables with TSQM scores, and Spearman’s rank correlation to compare categorical variables with TSQM scores.

Results
Of the 243 eligible patients, 80 (32.9%) responded (Table 1). Of these, 34 (42.5%) reported satisfaction with CCH treatment. On average, surveys were completed 4.7 (SD 2.3) years after last CCH injection. Age at presentation, at last CCH injection, and at survey completion were significantly correlated with satisfaction with side effects (Spearman's ρ= 0.32, 0.32, 0.33, respectively; p&lt;0.004 for all) (Table 2). Curvature degree, plaque diameter, and plaque volume measured before CCH treatment and the amount of change in these parameters were not significantly associated with TSQM scores. However, having any improvement in curvature significantly increased the GS subdomain score without affecting the TSQM total score (GS means 37.6 change v 20.7 no change; p=0.03). Greater final curvature degree and plaque volume after CCH completion were significantly correlated with lower TSQM total scores (Spearman's ρ= -0.36, -0.32, respectively; p&lt;0.04 for both). 10 (12.5%) patients reported depression, which significantly decreased scores of the effectiveness subdomain, GS subdomain, and TSQM total (p&lt;0.04 for all). 10 (12.5%) patients proceeded to surgical intervention after CCH treatment and reported significantly decreased scores in the effectiveness subdomain and TSQM total (p= 0.008, 0.001, respectively).

Conclusions
Our data suggests that older patients exhibit greater long-term satisfaction and tolerability of side effects from CCH. Additionally, final curvature and plaque volume after CCH completion were the most important objective predictors of long-term satisfaction rather than the degree of change in these parameters. Patients with depression also reported lower long-term satisfaction rates with CCH treatment.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: M.K. acts as a consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast. M.K. is an investor of Sprout. L.L. acts as a consultant for AbbVie, Aytu BioScience, Contraline, Lipocine. L.L. acts as an advisor for Inherent Bioscences. L.L. acts as consultant/speaker for Endo Pharmaceuticals. L.L. acts as a speaker for American Medical Systems/Boston Scientific.