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Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis.
J Sex Med. 2019 Feb; 16(2):289-299.JS

Abstract

INTRODUCTION

Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate.

AIM

To compare the efficacy of different classes of intralesional therapy with a network meta-analysis (NMA) method.

METHODS

The search was conducted using documents published in PubMed, Scopus, and Web of Science databases until September 30, 2017. We included randomized controlled trials comparing at least 1 intralesional therapy with a placebo therapy or with another drug for the treatment of PD. All intralesional therapies have been considered: collagenase Clostridium histolyticum (CCH), hyaluronic acid, verapamil, and interferon α-2b.

MAIN OUTCOME MEASURE

Outcomes of the study are the mean change in penile curvature (PC) and in erectile function (EF) assessed with the International Index of Erectile Function questionnaire.

RESULTS

In total, 8 comparisons matched with the inclusion criteria, which includes 1,050 patients. With regard to PC (degree) improvement, hyaluronic acid and verapamil showed worse outcomes when compared with CCH (-6.66 and -2.30) and interferon α-2b (-6.75 and -2.38). When considering improvement in EF, hyaluronic acid, verapamil and interferon α-2b showed a slight increase in mean change when compared with CCH (+2.39, +1.77, and +0.65). Moreover, verapamil and interferon α-2b showed slightly worse mean change in comparison to hyaluronic acid (+0.62 and +1.74), whereas interferon α-2b was worse than verapamil (-1.12).

CLINICAL IMPLICATIONS

Based on this NMA, empirical therapy for PD should be avoided to offer the patients the best treatment in terms of level of evidence.

STRENGTHS & LIMITATIONS

In this NMA, we have provided, for the first time, evidence of the efficacy between different intralesional therapies for the treatment of PD. We were not able to compare all specific outcomes (ie, pain, plaque size, patient satisfaction) of PD, because of the lack of homogeneity across relevant studies. Moreover, because of the few included studies, a meta-regression analysis of predictive factors of treatment response was not calculated.

CONCLUSION

This is the first meta-analysis comparing all available intralesional treatments for PD. CCH and interferon α-2b showed the best outcome in terms of PC, whereas hyaluronic acid was most efficient in relation to EF. Russo GI, Cacciamani G, Cocci A, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. J Sex Med 2019;16:289-299.

Authors+Show Affiliations

Urology section-University of Catania, Catania, Italy. Electronic address: giorgioivan1987@gmail.com.Urologic Clinic, University of Verona, Verona, Italy.Department of Urology, University of Florence, Italy.Department of Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.Urology section-University of Catania, Catania, Italy.Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey.Department of Urology, University Hospitals Leuven, Leuven, Belgium.Department of Neurosciences, Reproductive Sciences, Odontostomatology, Urology Unit, University of Naples, Naples, Italy.No affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30692028

Citation

Russo, Giorgio Ivan, et al. "Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: a Systematic Review and Network Meta-Analysis." The Journal of Sexual Medicine, vol. 16, no. 2, 2019, pp. 289-299.
Russo GI, Cacciamani G, Cocci A, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. J Sex Med. 2019;16(2):289-299.
Russo, G. I., Cacciamani, G., Cocci, A., Kessler, T. M., Morgia, G., Serefoglu, E. C., Albersen, M., & Verze, P. (2019). Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. The Journal of Sexual Medicine, 16(2), 289-299. https://doi.org/10.1016/j.jsxm.2018.12.011
Russo GI, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: a Systematic Review and Network Meta-Analysis. J Sex Med. 2019;16(2):289-299. PubMed PMID: 30692028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. AU - Russo,Giorgio Ivan, AU - Cacciamani,Giovanni, AU - Cocci,Andrea, AU - Kessler,Thomas M, AU - Morgia,Giuseppe, AU - Serefoglu,Ege Can, AU - Albersen,Maarten, AU - Verze,Paolo, AU - ,, Y1 - 2019/01/26/ PY - 2018/09/28/received PY - 2018/12/15/revised PY - 2018/12/24/accepted PY - 2019/1/30/pubmed PY - 2020/3/27/medline PY - 2019/1/30/entrez KW - Collagenase KW - Hyaluronic Acid KW - Intralesional Therapy KW - Medical Therapy KW - Penile Curvature KW - Peyronie’s Disease KW - Verapamil SP - 289 EP - 299 JF - The journal of sexual medicine JO - J Sex Med VL - 16 IS - 2 N2 - INTRODUCTION: Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate. AIM: To compare the efficacy of different classes of intralesional therapy with a network meta-analysis (NMA) method. METHODS: The search was conducted using documents published in PubMed, Scopus, and Web of Science databases until September 30, 2017. We included randomized controlled trials comparing at least 1 intralesional therapy with a placebo therapy or with another drug for the treatment of PD. All intralesional therapies have been considered: collagenase Clostridium histolyticum (CCH), hyaluronic acid, verapamil, and interferon α-2b. MAIN OUTCOME MEASURE: Outcomes of the study are the mean change in penile curvature (PC) and in erectile function (EF) assessed with the International Index of Erectile Function questionnaire. RESULTS: In total, 8 comparisons matched with the inclusion criteria, which includes 1,050 patients. With regard to PC (degree) improvement, hyaluronic acid and verapamil showed worse outcomes when compared with CCH (-6.66 and -2.30) and interferon α-2b (-6.75 and -2.38). When considering improvement in EF, hyaluronic acid, verapamil and interferon α-2b showed a slight increase in mean change when compared with CCH (+2.39, +1.77, and +0.65). Moreover, verapamil and interferon α-2b showed slightly worse mean change in comparison to hyaluronic acid (+0.62 and +1.74), whereas interferon α-2b was worse than verapamil (-1.12). CLINICAL IMPLICATIONS: Based on this NMA, empirical therapy for PD should be avoided to offer the patients the best treatment in terms of level of evidence. STRENGTHS & LIMITATIONS: In this NMA, we have provided, for the first time, evidence of the efficacy between different intralesional therapies for the treatment of PD. We were not able to compare all specific outcomes (ie, pain, plaque size, patient satisfaction) of PD, because of the lack of homogeneity across relevant studies. Moreover, because of the few included studies, a meta-regression analysis of predictive factors of treatment response was not calculated. CONCLUSION: This is the first meta-analysis comparing all available intralesional treatments for PD. CCH and interferon α-2b showed the best outcome in terms of PC, whereas hyaluronic acid was most efficient in relation to EF. Russo GI, Cacciamani G, Cocci A, et al. Comparative Effectiveness of Intralesional Therapy for Peyronie's Disease in Controlled Clinical Studies: A Systematic Review and Network Meta-Analysis. J Sex Med 2019;16:289-299. SN - 1743-6109 UR - https://wwww.unboundmedicine.com/medline/citation/30692028/Comparative_Effectiveness_of_Intralesional_Therapy_for_Peyronie's_Disease_in_Controlled_Clinical_Studies:_A_Systematic_Review_and_Network_Meta_Analysis_ DB - PRIME DP - Unbound Medicine ER -