In 1743, Francois Gigot de la Peyronie, surgeon to Louis XV of France, described the condition of penile curvature in a medical treatise. Some 270 years later, the condition, Peyronie’s Disease (PD), has taken his name but a definitive explanation of its cause has not yet been determined.
At least three percent of adult males, mostly between the ages of 40-60, suffer from Peyronie’s Disease. It is far more than a cosmetic problem as severe PD can cause pain upon erection or prohibit intercourse. PD can worsen over time, causing greater and greater degrees of curvature, leading to erectile dysfunction as well as shortening and disfigurement of the penis.
Recent research exploring the causes of PD focus on it being an autoimmune disease or the result of vascular trauma or injury to the penis, through sexual activity, sports or accident. Even minor traumas can result in microscopic damage to vessels and tissues and, over time, result in a hard scar tissue (plaque) build up in the tissue of the tunica albuginea, a thick, elastic membrane in the penis that is involved in maintaining an erection. The plaque deposits decrease the elasticity of the penis and lead to the characteristic curvature of PD.
Until recently, options for correcting moderate to severe PD were limited. “All physicians could offer were off-label use of medications that produced varying degrees of response, or surgery, which was the only way to really fix the problem,” said Dr. Evan R. Goldfischer, co-managing director of Premier. “Now, with Xiaflex, there is a new FDA-approved prescription medication that is an exciting, significant development in PD treatment.”
Xiaflex—comprised of the enzyme collagenase clostridium histolyticum—serves to weaken and break down the plaque responsible for the penile curvature of PD and has been shown to aid in straightening of the penis for many patients. The medication protocol promises an alternative to major surgery and has the benefit of being performed in the physician’s office.
Xiaflex can only be administered by a physician specifically trained in the process. Its use is restricted to adult men with PD who have a plaque that can be felt by palpation and a curve in the penis greater than 30 degrees at the time treatment is initiated.
The protocol consists of direct injections of Xiaflex into the plaque in the penis. The physician helps the process of plaque break down through massage and stretching of the treated area and the patient follows a daily regimen of exercises to aid straightening of the curvature.
“So far, the side effects we’ve seen have been minimal and have been well tolerated,” says Goldfischer. “We are only several cycles into Xiaflex treatment for our patients, so it’s too early to say that we’ve had success. What I can say is that our patients tell us they are very happy.”
Xiaflex is expensive a full course of treatment can require multiple injections and take up to 24 weeks. “Working in concert with our representative in the field, we have been able to arrange third-party reimbursement for every vial our PD Xiaflex patients have needed,” says Goldfischer. The medication is still new, having received FDA approval for the treatment of PD in 2013, but it is expected to be covered by most major insurance companies in the near future.
“We hope that this non-surgical treatment, administered in the doctor’s office with the very good results we’re seeing thus far, will induce other patients with PD to come to us earlier for treatment. To be able to take away their physical pain and the psychological pain of being completely unable to have intercourse makes us happy and we think the patients and their partners will be, too.”
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