Dr. Mills on CCH treatment in the acute phase of Peyronie’s disease

In this video, Jesse N. Mills, MD, highlights the background and notable findings from the study, “Participants with Penile Pain at Baseline May Benefit from Collagenase Clostridium Histolyticum Treatment: A Post Hoc Analysis,” which he will present at the 2023 SMSNA Annual Meeting in San Diego, California. Mills is the director of the men’s clinic at the University of California, Los Angeles (UCLA) and a clinical professor of urology at the David Geffen School of Medicine at UCLA.

Video Transcript:

The traditional teaching in Peyronie's is we break it down into what we call the acute phase and the chronic phase. The acute phase you think of mostly as the time that you've had the condition to when you present for care, being, say, 6 months or a year, and the chronic phase being somewhere after that. What we've also found is that we characterize whether or not a man is still suffering from pain with Peyronie's disease before they seek treatment. The classic teaching is if somebody is still having pain, then they are in the acute phase and therefore maybe we would hold off in treating them with Xiaflex, which we've looked at mostly in the chronic phase. So, a man comes in, he's having acute pain, he's having a curvature. Then we say "Let's give this time to settle down. Let's not start something like this." And essentially what we're telling patients is, "wait for it to get worse". That is the classic paradigm right now. Wait for it to get worse, because Peyronie's almost never gets better on its own. You have to have some sort of intervention. When we look back at the original data that led to the FDA approval of Peyronie's, we did see men that were in that chronic phase–because nobody was allowed into the study if they hadn't had the disease for less than 12 months–but some of them still had pain, and we injected. What we found is that it had no bearing on their outcomes. In other words, men with pain didn't suffer worse complications, they didn't have more pain. They did just as well as men that had stabilized plaque and no pain. It's really great because that means we can look at treating men sooner even if they're still presenting, and in what we would traditionally or classically call the acute phase, we're able to offer an FDA approved therapy at an earlier timeline. And pain, as we know, drives a lot of men to come to the hospital. I always say the field of men's health wouldn't be there if guys would not come to the doctor only if there's something wrong with their penis, or they have a bone sticking out of them somewhere. That's their access to care. So, pain drives people to the doctor's office. The last thing you'd want to do is see a man with pain and say, "Hey, just give it some time; it'll get better. No need to do anything at this point." Now we know that actually there are things we can do to not only alleviate the pain, but improve the condition that they're coming to see us for.

This transcription has been edited for clarity.