Urology section-University of Catania, Catania, Italy.
Urologic Clinic, University of Verona, Verona, Italy.
J Sex Med. 2019 Feb;16(2):289-299. doi: 10.1016/j.jsxm.2018.12.011. Epub 2019 Jan 26.
Medical treatment of Peyronie's disease (PD) in terms of intralesional therapy is still a matter of debate.
To compare the efficacy of different classes of intralesional therapy with a network meta-analysis (NMA) method.
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.
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.
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).
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.
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.
在阴茎硬结症（PD）的治疗中，腔内治疗仍然存在争议。
采用网络荟萃分析（NMA）方法比较不同类别的腔内治疗的疗效。
检索 PubMed、Scopus 和 Web of Science 数据库中截至 2017 年 9 月 30 日发表的文献，纳入比较至少 1 种腔内治疗与安慰剂或其他药物治疗 PD 的随机对照试验。所有腔内治疗均被考虑：胶原酶 C 型溶组织梭菌（CCH）、透明质酸、维拉帕米和干扰素 α-2b。
研究的结局是采用国际勃起功能指数问卷评估的阴茎弯曲度（PC）和勃起功能（EF）的平均变化。
共有 8 项符合纳入标准的比较，包括 1050 例患者。在 PC（度）改善方面，透明质酸和维拉帕米的疗效较 CCH（-6.66 和-2.30）和干扰素 α-2b（-6.75 和-2.38）差。在 EF 改善方面，透明质酸、维拉帕米和干扰素 α-2b 与 CCH 相比，平均变化略有增加（+2.39、+1.77 和+0.65）。此外，与透明质酸相比，维拉帕米和干扰素 α-2b 的平均变化稍差（+0.62 和+1.74），而干扰素 α-2b 比维拉帕米差（-1.12）。
基于这项 NMA，为了给患者提供最佳的治疗效果，应该避免经验性治疗 PD。
在这项 NMA 中，我们首次提供了不同腔内治疗 PD 的疗效证据。由于相关研究缺乏同质性，我们无法比较 PD 的所有特定结局（即疼痛、斑块大小、患者满意度）。此外，由于纳入的研究较少，因此未计算治疗反应的预测因素的元回归分析。
这是第一项比较 PD 所有现有腔内治疗的荟萃分析。CCH 和干扰素 α-2b 在 PC 方面的疗效最好，而透明质酸在 EF 方面最有效。Russo GI、Cacciamani G、Cocci A 等人。《阴茎硬结症对照临床试验中腔内治疗的比较效果：系统评价和网络荟萃分析》。J 性医学 2019；16：289-299。
