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Evaluating responders to collagenase clostridium histolyticum treatment for Peyronie disease


“[Collagenase clostridium histolyticum (Xiaflex)] is an incredibly important part of the treatment armamentarium for Peyronie's disease in the US,” says Matthew J. Ziegelmann, MD.

In this video, Matthew J. Ziegelmann, MD, discusses future research building on the recent Urology paper, “Incremental Treatment Response by Cycle With Collagenase Clostridium Histolyticum for Peyronie's Disease: a Pooled Analysis of Two Phase 3 Trials.”Ziegelmann is a urologist at Mayo Clinic in Rochester, Minnesota.


[Collagenase clostridium histolyticum (Xiaflex)] is an incredibly important part of the treatment armamentarium for Peyronie's disease in the US. I certainly have an interest in continuing to pursue research in this realm, as do many others. I think the next steps, and this is sort of the unanswered question in Peyronie's disease and in intralesional therapy with collagenase, who is the right candidate? We have criteria that have been set out by the package insert for the medication based on the inclusion criteria for these studies. It's 30-degree curvature with a palpable plaque. Usually, it's in the setting of someone who doesn't have significant calcification of that scar that prevents administration of the medication. But beyond that, we still see a nonresponder rate. We saw that in these original phase 3 data; we see that in clinical practice every day. That's an incredibly frustrating thing for patients undoubtedly, but for us as clinicians too, because we want to be offering these rigorous therapies if we think they're going to work. So who is that patient? Who is that patient who's going to respond? In this study, we actually did another analysis saying, Okay, if you had calcification in your scar—not severe calcification, but some calcification—did that predict whether you would respond or what the overall outcomes were for the cohort? The answer was no. We also looked at the direction of curve: up/down, left/right. Downward curvature was not included, so it was basically dorsal or lateral and dorsolateral. That didn't seem to predict outcomes as well. We need to find other predictors. That has been attempted with the datasets we have based on some of these clinical series. But it's still really early. That's where I think the research needs to take us. Who are these patients who don't respond? And on the flip side, who are the patients who have this incredible response? Who are those guys who go from a 45-degree curve to nearly perfectly straight? And how can we identify those mega responders? Those are things that I'm interested in and I think a lot of other people who study this are interested in as well.

This transcription was edited for clarity.

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