Xiaflex for Peyronie's Disease

Peyronie’s Disease refers to a localized deposit of collagen tissue – scar tissue – along the penile shaft. During erection this inelastic tissue causes the penis to curve toward the side of the deposit often making intercourse difficult or impossible. An estimated 100,000 men may receive this diagnosis each year with most remaining untreated. Recent advertisements appearing on the television promote a drug known as Xiaflex and suggest more information is available at the website learnaboutpd.com. Xiaflex contains two bacterial enzymes, collagenases, capable of dissolving collagen. In theory the drug seems to offer significant advantages to men with the condition, but the benefits are tempered with significant likelihood of problems. Injection directly into the collagen deposits occur on day zero and are repeated one time after passage of 1-3 days. Then the man returns after another 1-3 days for manual stretching and “modeling” of the penis. The cycle is repeated up to a total of 4 times. The initial curvature averages 40°-50° but may extend up to 90°. The goal of therapy is deviation of less than 15° from normal. Most men achieve moderate but not complete success. Prominent side effects include fracture of the penis, hematoma, swelling, pain and bleeding into the skin. The majority of patients will experience at least some of these adverse effects. The company behind the drug Endo International appears in legal and financial peril. Federal, state and local authorities are suing over the company’s now withdrawn opioid drug. Other problems relate to their vaginal mesh and testosterone gel. Whether Xiaflex adds to their misery remains uncertain. Each vial of Xiaflex carries a cash price of about $4500 with two vials necessary for each round of treatment.