(264) Reasons of Discontinuation from Collagenase Clostridium histolyticum treatments in Peyronie’s Disease

Abstract

Abstract Introduction Peyronie’s disease is an acquired fibrotic condition that impacts quality of life and sexual function. Intralesional Collagenase Clostridium histolyticum (CCH) is the only FDA approved medication to correct curvature. The treatment consists of 8 injections over 26 weeks and previous studies indicate that greater improvement is associated with a greater number of injections; however, reasons for early discontinuation are not well studied. Objective We aimed to understand the reasons for early discontinuation of CCH treatment in a major academic system. Methods We retrospectively reviewed charts of PD patients from October 2018 to October 2020 who underwent CCH treatment. Complete treatment consists of four cycles of two injections, each separated by approximately 5-6 weeks, for a total of 8 injections. Treatment completion was defined as receiving 8 injections or stopping because curvature decreased to <15 degrees. Patients who did not complete 8 injections were contacted and surveyed about reasons for discontinuation. Data was gathered and analyzed on Microsoft Excel. Results A total of 73 patients elected for CCH. Only 43 (58.9%) completed all 8 injections and another 5 (6.8%) stopped due to treatment satisfaction, for a total of 48 (66%) reaching endpoint. There was no significant difference in age, duration of symptoms or Peyronie’s Disease Questionnaire scores between patients who completed treatment and those who didn’t (Table 1). Similar number of patients dropped out in the first half and second half of treatment. Out of the 30 (41.1%) of patients who discontinued therapy before 8 injections, 4 (13.3%) wanted to try another treatment, 6 (20%) experienced side effects, 3 (10%) had insurance issues, 5 (16.7%) was satisfied after a few injections, 4 (13.3%) was disappointed in treatment and 8 (26.7%) were unable to be contacted to return to the hospital (Table 2). Conclusions We found that shifts in financial/insurance status and onset of adverse events, such as an autoimmune flair, were predictive of dropouts in our cohort. Most of the patients who wanted to attempt another treatment did so with the same surgeon but wanted a faster solution. Further, in our cohort, difficulty contacting patients was the biggest reason of discontinuation; this is likely skewed due to the COVID19 pandemic as patients relocated or underwent fewer elective treatments and procedures. To reduce CCH discontinuation, we propose that counseling should focus on potential adverse events, speed of change and financial assistance. Disclosure No