(309) Risk Factors Associated with the Utilization of Xiaflex Injections for Peyronie’s Disease

Abstract

Abstract Introduction Collagenase clostridium histolyticum (CCH), known as Xiaflex (Endo Pharmaceuticals Dublin, Ireland) is the only FDA approved medication for Peyronie’s Disease (PD) in the United States. While Xiaflex has shown efficacy with improvement of curvature by >20% in over half of recipients, patients are hesitant to pursue treatment due to the monetary costs, length of treatment, and perception of injectable therapy. Objective The aim of this study is to determine if demographic and clinical factors are associated with clinical decision making to pursue Xiaflex injections for treatment of PD. Methods We retrospectively reviewed patients who presented to our institute from 2009 to present with PD. Demographic and clinical parameters were extracted. Independent T-test and Wilcoxon rank sum tests were used to determine correlation between continuous variables and whether Xiaflex was selected. Odds ratios with 95% confidence interval were used to determine association between categorical variables and whether Xiaflex was pursued. Results 143 patients presented with PD. Of these cases, 24.5% (35) received Xiaflex and 75.5% (108) declined Xiaflex. There was no significant difference in age, months since curvature was first noted, history of erectile dysfunction (ED), ED response to PDE5 inhibitors, history of hypogonadism, lowest total and free testosterone levels documented, history of GU trauma, history of depression or anxiety, hourglass deformity, past urethral instrumentation, SHIM score, plaque volume, maximum plaque diameter on ultrasound, distance of curve apex from coronal sulcus, or history of Dupuytren’s contracture between the treatment and nontreatment group (P>0.05). Subjects who chose treatment had significantly greater predicted curvature and degree of curvature on initial ultrasound at the time therapy was offered compared to those who did not select treatment. Patients who received Xiaflex had an average predicted curvature at presentation of 49.5 degrees (sd = 28.1) and degree of curvature on initial ultrasound of 50.02 degrees (sd=20.0) respectively. Patients who did not receive Xiaflex had an average predicted degree of curvature at presentation of 37 degrees (sd=23.8) and degree of curvature on initial ultrasound of 37.6 (sd=23.0). Conclusions Our data suggests that PD patients who chose treatment with Xiaflex had greater penile average curvature compared to those who did not choose treatment. Despite erectile function, comorbidities, and radiographic findings, degree of penile curvature remains a key risk factor for selecting injectable therapy for PD. Disclosure No