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Collagenase clostridium histolyticum is no longer available in Europe: what does this mean for our patients with Peyronie’s Disease?

International Journal of Impotence Research volume 33, pages 376–377 (2021)Cite this article

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Since 1743 when Francois de la Peyronie first described treatment for Peyronie’s disease (PD) with mercury, many different treatments have been proposed [1]. Yet, few treatments have consistently shown efficacy for treating penile curvature [2]. Fast forward more than two and a half centuries and, although substantive advances in medical technology for diagnosing and managing a multitude of complex medical conditions, our treatment armamentarium for PD remains notably scant. Oral therapies continue to be prescribed by many clinicians despite an overwhelming lack of supportive data and several expert guideline panels recommending against the use of specific agents [3,4,5]. Penile traction, which was first used to treat PD in the early 21st century, is only now gaining traction as a first line therapy to improved curvature and penile length [6]. Surgery, such as tunica albuginea plication or plaque incision and grafting, is still considered the gold-standard approach for correcting penile curvature but is not preferred by many patients due to potential morbidity.

For patients who desire a more definitive treatment, but want to avoid surgery and the potential adverse effects, intralesional injection therapy is an excellent option. Injections with interferon α-2B and verapamil have a long-standing track record, but rigorous study data to evaluate treatment efficacy are relatively limited [7, 8]. In 2013, Gelbard et al. published outcomes from the landmark Investigation for Maximal Peyronie’s Reduction Efficacy and Safety Studies (IMPRESS I/II), a combined post-hoc meta-analysis of data from two large double-blind, randomized, placebo-controlled phase three trials comparing intralesional collagenase clostridium histolyticum, a bacterial-derived proteolytic enzyme that preferentially targets type I and III collagen (prominent in PD plaque), to placebo [9]. The authors reported an average 17° (34%) improvement in penile curvature compared with 9° (18%) in the control arm. Symptom bother as measured by the validated PD questionnaire was also significantly lower after treatment. A number of additional single and multi-institutional clinical studies have corroborated these findings lending further credence to this approach [10]. Ultimately, these data garnered regulatory body approval for collagenase and, to date, it is the only licensed nonsurgical approach to treat PD. The therapy is approved for Dupuytren’s contracture as well, a condition involving the palmar flexor tendons of the hand that is known to co-occur in a relatively high percentage of PD patients [11].

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Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Matthew J. Ziegelmann

  2. Department of Urology, University of California-Irvine, Orange, CA, USA

    Faysal A. Yafi

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Correspondence to Faysal A. Yafi.

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FAY: Coloplast Corporation (consultant, advisory board) and Endo Pharmaceuticals (consultant, advisory board, speaker). MJZ: no pertinent conflicts of interest.

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Ziegelmann, M.J., Yafi, F.A. Collagenase clostridium histolyticum is no longer available in Europe: what does this mean for our patients with Peyronie’s Disease?. Int J Impot Res 33, 376–377 (2021). https://doi.org/10.1038/s41443-020-0271-3

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