Section of Urology
University of Manitoba
Canadian provider perspectives on Collagenase Clostridium histolyticum for the treatment of Peyronie’s disease and the impact of its discontinuation
Uday Mann1, Benjamin Shiff1, Kunal Jain1, Ryan Flannigan2, Dean S. Elterman3, Premal Patel1.
1Section of Urology, University of Manitoba, Winnipeg, MB, Canada; 2Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; 3Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
Introduction: Intralesional Collagenase Clostridium histolyticum (CCh) was the first non-surgical therapy approved for Peyronie’s disease (PD). However, CCh’s cost and poor market uptake has led to its discontinuation in Europe and Canada. The aim is tobetter understand Canadian providers’ perspectives regarding its treatment efficacy and the potential impact of its discontinuation.
Methods: All Xiaflex®-approved Canadian providers were asked to complete an anonymous 20-question survey using an online platform in the summer of 2020. Analysis consisted of descriptive statistics. Outcomes of interest included previous experience with CCh, protocols utilized, experience with insurance coverage, clinical and patient-reported outcomes, and provider perspectives on the discontinuation of CCh.
Results: Overall response rate was 48.3% (29/60) (see Table 1). 93% of respondents felt that CCh was superior to other intralesional therapies for PD. 86% reported a patient satisfaction rate of at least 50%, and the majority (75%) saw a clinically meaningful response (Figures 1 and 2). Only 7% expressed difficulty obtaining insurance coverage, with many providers (71%) achieving an insurance approval rate between 75-100%. Only 54% of respondents reported that they would continue treating PD in light of CCh’s discontinuation. In light of CCh’s discontinuation, few will offer intralesional verapamil (36%) or interferon (7%), and most (79%) are now more likely to offer surgical treatment.
Conclusion: Most CCh providers found CCh to be effective and were dismayed by its discontinuation. The discontinuation of CCh in Canada will lead to a reduction in the number of Canadian urologists offering PD treatment, with increased propensity to offer surgical treatment among those who remain. The survey demonstrated that due to the withdrawal of CCh from Canada, physicians’ abilities to offer effective medical therapy may become limited, with more providers offering surgical options for PD.