(398) The Correlates of Satisfaction with Long-term Outcomes Following Collagenase Clostridium Histolyticum Treatment for 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 experienced improvements in curvature by more than 20% in the IMPRESS I/II trials. Despite objective improvements in PD severity, some patients still report dissatisfaction with CCH treatment. The effects of subjective reasons of greatest satisfaction and dissatisfaction on long-term overall treatment satisfaction is even less clear.

Objective
The aim of this study was to assess how subjective patient responses regarding reasons for satisfaction and dissatisfaction correlate to long-term satisfaction with CCH treatment.

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. The questionnaire also included multiple-choice questions on CCH insurance coverage, reasons for greatest satisfaction and dissatisfaction with a free-response “other” answer choice, and likelihood of recommending CCH to other patients with PD on a scale from 0-6. Statistical analyses were performed in R using Wilcoxon rank sum test and independent T-test to compare continuous variables with TSQM scores, Spearman’s rank correlation to compare categorical variables with TSQM scores, and Fisher's exact test to compare categorical variables with one other.

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. When queried on what factors patients were the most satisfied with, improvements in curvature and sexual function were significantly correlated with increased scores in the effectiveness subdomain, GS subdomain, and TSQM total (p&lt;0.01 for all) (Table 2). 30 (37.5%) patients self-reported no satisfaction because of no perceived improvement in the same question, which significantly correlated with decreased scores in the effectiveness subdomain, GS subdomain, and TSQM total (p&lt;0.0001 for all). Of this cohort, 26 (86.7%) patients would not recommend CCH to other patients with PD (OR 10.27, 95% CI 2.94-46.85, p=0.00002). When queried on what factors patients were the most dissatisfied with, pain with injection, duration of CCH series, and no improvements in curvature were all significantly associated with lower scores in effectiveness subdomain, GS subdomain, and TSQM total (p&lt;0.003 for all). Patients with insurance coverage had lower odds of reporting cost of CCH as their greatest dissatisfaction (OR 0.05, 95% CI 0.004-0.62, p=0.03).

Conclusions
Our data suggests that the most important factors for long-term patient satisfaction with CCH treatment are improvements in curvature and sexual function while the most important factors for patient dissatisfaction are pain with injection, duration of CCH series, and no improvements. While pain with injection is temporally brief, it continues to negatively affect patient satisfaction even years after completion of CCH.

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.