A systematic review and network meta-analysis on the clinical efficacy of intralesional therapy for Peyronie’s Disease in controlled clinical trials
Russo, GI1; Cacciamani, G2; Cocci, A3; Kessler, T4; Morgia, G1; Serefoglu, EC5; Verze, P6; Albersen, M7
1: Urology Section, University of Catania, Italy; 2: Department of Urology, University of Verona, Italy; 3: Department of Urology, University of Firenze, Italy; 4: Department of Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; 5: Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey; 6: Department of Urology, University of Naples Federico II, Naples, Italy; 7: Department of Urology, University Hospitals Leuven, Leuven, Belgium
Objectives: The medical treatment of Peyronie’s disease (PD) in term of intralesional therapy is still a matter of debate. We aimed to compare the clinical efficacy of different classes of intralesional therapy through a network meta-analysis method.
Material and Methods: The search was conducted until 30 September 2017 using Medline, Scopus and Web of Science databases without restriction on year of publication, using PICO review protocol. We included randomized controlled studies comparing at least one intralesional therapy with placebo or with another drug in the treatment of Peyronie’s disease. All intralesional therapy have been considered: Collagenase c. Histolytcum (CCH) , Hyaluronic acid, Verapamil and Interferon-alpha-2b. Outcomes of the study were the mean change in penile curvature (PC) and in erectile function (EF) assessed with the International Index of Erectile Function (IIEF) questionnaire.
Results: In total, 1721 articles were identified after the electronic search in PubMed (n = 646), Scopus (n = 629) and Web of Science (n = 446). After the global assessment, 8 studies matched with the inclusion criteria, including 1,050 patients. We reported heterogeneity between studies based on duration of protocol and follow-up. For PC (degree), the mean efficacies against placebo were as following: Collagenase: +0.41, Hyaluronic acid: +6.25, Verapamil: +1.88 and Interferon a-2b: -0.50 (Figure 1). However, for PC mean changes between therapy, CCH showed better results versus Hyaluronic acid and Verapamil, +6.66 and +2.30, while Interferon a-2b exhibited similar results (-0.09). Interferon a-2b showed better improvement than Verapamil (-2.38) (Figure 2).
For erectile function the mean efficacies against placebo were as following: CCH: +0.61, Hyaluronic acid: +1.78, Verapamil: +1.16 and Interferon a-2b: 0.04. Hyaluronic acid (+2.39), Verapamil (+1.77) and Interferon a-2b (+0.65) showed slightly increase respect to CCH. Based on the SUCRA rankograms, Interferon a-2b and Collagenase1 showed the highest score, 56.9% and 56.3%, respect to other active treatment.
Conclusions: In this network meta-analysis on all available intralesional treatment for PD, we demonstrated that CCH showed the better outcome in terms of PC, while Hyaluronic acid showed the better outcomes in terms of EF.
Figure 1. Network meta-analysis for penile curvature improvement for different treatment effects. (Coll= Collagenase; Pla= Placebo; Hyal=Hyaluronic acid; Ver=Verapamil; Interf=Interferon a-2b).
Figure 2. Network meta-analysis for erectile function improvement for different treatment effects. (Coll= Collagenase; Pla= Placebo; Hyal=Hyaluronic acid; Ver=Verapamil; Interf=Interferon a-2b).
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