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Discontinuation from Collagenase Clostridium histolyticum Therapy for Peyronie's Disease: Review and Single-Center
Arash Amighi1, Sriram V Eleswarapu1, Neil Mendhiratta1
1Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA.
Introduction:
Intralesional injection therapy with collagenase Clostridium histolyticum (CCh) is an effective treatment option for Peyronie's disease (PD), but it carries risks, costs, and the need for multiple visits, which may cause patients to discontinue therapy prematurely.
Aims:
To identify and summarize the current literature on CCh discontinuation and present our experience with CCh discontinuation.
Methods:
We performed a PubMed review of existing literature on discontinuation from CCh therapy and retrospectively analyzed our prospectively maintained Institutional Review Board-approved CCh database for January 2016-December 2018. Demographic information, clinical outcomes, and communication logs were collected. Reasons for discontinuation of therapy were assessed. A logistic regression to identify factors influencing dropout was performed.
Main Outcome Measures:
Documentation of discontinuation statistics in published literature, and rates of and reasons for discontinuation in a single-institution cohort.
Results:
Our literature review identified 15 studies with specified cohort sizes. Of these, 10 specifically quantified discontinuation rates, which ranged from 13% to 56%. Combined, these studies show a 20% dropout rate. Dissatisfaction with therapy was the most common reason for dropout. In our cohort, 100 men completed a course of 8 CCh injections. Twelve men (10.7%) discontinued therapy, including 4 due to relocation, 3 due to cost, 1 due to a hematoma, 1 due to early satisfaction, 2 due to no perceived improvement, and 1 due to a demanding work schedule. Hematoma formation was a predictor of dropout in our cohort (odds ratio 8.74; P = .037).
Conclusion:
Additional focus must be placed on quantifying and evaluating CCh discontinuation. Our findings show that a majority of men complete a full course of 8 injections; most of the few men who dropped out of therapy did so due to relocation. Counseling to reduce CCh discontinuation should focus on initial sexual function, adverse events, and expectations. Amighi A, Eleswarapu SV, Mendhiratta N, et al. Discontinuation from Collagenase Clostridium histolyticum Therapy for Peyronie's Disease: Review and Single-Center Cohort Analysis. Sex Med Rev 2019;7:690-698.