Xiaflex (collagenase clostridium histolyticum) / Asahi Kasei, SOBI, Endo - LARVOL DELTA

Determining Risk Factors and Rate of Surgery After Collagenase Injections for Dupuytren Contracture. (PubMed, J Hand Surg Glob Online) - "Further research is warranted to explore mechanisms underlying progression to surgery and prevention strategies. Prognostic/III."

Journal • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Diabetes • Epilepsy • Metabolic Disorders

IGF-I Transforms Fibrosis into Fat: IGF-I Induced Transdifferentiation of Dupuytren's Myofibroblasts into Adipocyte-Like Cells (PSTM 2025) - "Current standard treatment options involve excising or breaking down the fibrotic tissue – either via palmar fasciectomy or injection of collagenase clostridium histolyticum... This study offers mechanisms for discovering new therapeutic targets for treating skin fibrosis, using Dupuytren disease as a model with possible implications in other fibrotic conditions. Identifying IGF-I as a functional replacement for PRP in inducing transformation of DMFs to adipocyte-like cells in vitro is both a novel and important finding given the translational limitations of PRP as a treatment modality. However, the use of ASCs has similar limitations."

Fibrosis • Immunology • IGF1

Review of Current Non-Invasive Peyronie's Disease Management: A Changing Reality. (PubMed, Arch Esp Urol) - "Collagenase Clostridium Histolyticum (CCH) is the only Food and Drug Administration (FDA)-approved treatment available, and its withdrawal has removed a promising first-line treatment option for PD. Emerging evidence suggests that penile traction therapy may enhance treatment outcomes and is a promising complementary approach in future therapeutic strategies."

Journal • Review • Fibrosis

"Collagenase injections versus limited fasciectomy in treating patients with Dupuytren's contracture: A systematic review and meta-analysis". (PubMed, Int J Orthop Trauma Nurs) - "LF is superior in reducing recurrence and residual contracture but has a higher complication rate. CCH yields greater change in ED. Further research is needed to refine treatment strategies."

Journal • Retrospective data • Review

Efficacy and safety of collagenase clostridium histolyticum in treating primary hourglass deformities in atypical Peyronie's disease patients. (PubMed, J Sex Med) - No abstract available

Journal • Sexual Disorders

Early postinterventional clinical implications of Collagenase Clostridium Histolyticum injection versus limited fasciectomy for Dupuytren's disease. (PubMed, J Hand Microsurg) - "The results of this study suggest that CCH injections lead to less complicated wound healing requiring less intensive surgeon and hand therapy aftercare than LF. CCH represents a valuable addition to Dupuytren's disease treatment, allowing for repeated use in severe, complex, or recurrent cases without increasing procedure-related risks while offering versatility for combination with minimally invasive surgery."

Journal

Outcomes of limited fasciectomy, needle fasciotomy and collagenase injection for Dupuytren's disease: a systematic review and meta-analysis of individual patient data. (PubMed, J Hand Surg Eur Vol) - "This systematic review and meta-analysis of individual patient data evaluates the outcomes of treatment for Dupuytren's disease using limited fasciectomy (LF), percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH) injection...Overall, the clinically relevant contracture correction was comparable between LF, PNF and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence. Treatment decisions should consider the trade-off between complications and recurrence risk."

Journal • Retrospective data

The Impact of Emerging Therapies and Declining Physician Reimbursement on Dupuytren Disease Treatment: A 21-Year Review. (PubMed, J Hand Surg Am) - "The growing use of CCH as the dominant treatment for DC underscores how marketing and public awareness may influence treatment practices. Physicians have a responsibility to understand these influences, ensuring that treatment decisions are guided by clinical efficacy and cost-effectiveness while managing patient expectations and prioritizing long-term outcomes over trends driven by marketing."

Journal • Reimbursement • US reimbursement

Commentary on "Outcomes and management of Peyronie's disease with combined treatment of collagenase clostridium histolyticum, vacuum erection device, and tadalafil". (PubMed, Asian J Androl) - No abstract available

Journal

Editorial comment on "Outcomes and management of Peyronie's disease with combined treatment of collagenase clostridium histolyticum, vacuum erection device, and tadalafil". (PubMed, Asian J Androl) - No abstract available

Journal

Outcomes and management of Peyronie's disease with combined treatment of collagenase clostridium histolyticum, vacuum erection device, and tadalafil. (PubMed, Asian J Androl) - "Minor complications were observed in 15 patients, while 13 were dissatisfied with treatment, with six opting for surgery. The modified protocol demonstrated significant improvements in penile curvature and erectile function with minimal complications, offering a safe, cost-effective alternative to traditional intensive treatments."

Journal • Erectile Dysfunction • Pain • Rheumatology • Urology

Are patients undergoing intralesional collagenase Clostridium histolyticum injection therapy for Peyronie's disease compliant? A 7-year analysis from a tertiary care men's health center. (PubMed, J Sex Med) - "Overall compliance rate for CCH injection therapy was 70.89%. Greater curvature reduction was demonstrated in compliant patients. Common reasons for incomplete treatment included adverse effects (15.1%), early satisfaction with results (14.1%), and unknown factors (45.4%). However, missing data and bias from retrospective design are major limitations."

Journal • Pain

Response to Intralesional Collagenase Clostridium Histolyticum in Peyronie's Disease Patients with Concomitant Dupuytren's Contractures (AUA 2025) - "This study provides the first robust evidence that concomitant DC is associated with a superior response to CCH therapy in PD patients. The significantly greater curvature correction in the DC group suggests a potential synergistic effect of DC on CCH efficacy, meriting further investigation. These findings could influence clinical decision-making and patient counseling for men with PD and concurrent DC."

Clinical

Efficacy of a Novel Collagenase Clostridium Histolyticum Protocol for Peyronie's Disease Among Prior Non-responders: A Randomized, Controlled, Single-Blinded Study (AUA 2025) - P4 | "Men were randomized 3:1 to receive either CCH+traction (RestoreX)+sildenafil (treatment) up front or initial observation followed by treatment (controls). Repeating CCH using a novel protocol after an initially unsuccessful course of CCH achieves significant improvements in curvature and patient satisfaction. Additional data, including external validation, are warranted."

Clinical

Peyronie's disease outcomes following collagenase clostridium histolyticum may not differ by sexual orientation. (AUA 2025) - "In this series, patients who identified as MSM were with significantly higher rates of penile fracture following CCH. However, rates of complications requiring intervention, treatment satisfaction, and change in penile curvature were not statistically different in this population. While further work is needed to examine the use of CCH in this population, this data suggests that CCH may be used safely and with similar expected outcomes in the population of MSM."

Musculoskeletal Diseases

Efficacy And Safety Of Collagenase Clostridium Histolyticum Treatment In Patients With Complex Penile Plaques (AUA 2025) - "CCH injections significantly improved penile curvature in all plaque location groups, with no significant difference in the rate of most side effects between these five groups."

Clinical • Erectile Dysfunction • Musculoskeletal Diseases • Pain • Rheumatology

Injection therapy in the acute phase of Peyronie's disease: a systematic review of current evidence. (PubMed, J Sex Med) - "Injection therapy for the acute phase of PD demonstrates variable efficacy depending on the agent used and a relatively favorable safety profile; however, the overall quality of evidence remains low and is characterized by significant methodological limitations."

Journal • Pain

Comparative outcomes of intralesional collagenase injection for Peyronie's disease: acute vs. stable phase treatment. (PubMed, Int J Impot Res) - "Collagenase clostridium histolyticum (CCH) was FDA-approved for treating Peyronie's Disease (PD), demonstrating significant curvature improvement in patients during the stable phase of disease...A total of 55 patients (76.39%) in the stable phase and 23 patients (82.14%) in the acute phase showed improvement in curvature, with no significant differences in curvature outcomes or adverse events between the two groups. This study contributes to the growing evidence that intralesional CCH treatment during the acute phase of PD is safe and effective."

Journal • Pain

Mallinckrodt and Endo to Combine to Create a Global, Scaled, Diversified Pharmaceuticals Leader (PRNewswire) - "Mallinckrodt plc...and Endo, Inc...today announced that they have entered into a definitive agreement to combine in a stock and cash transaction to create a global, scaled, diversified pharmaceuticals leader...Mallinckrodt and Endo plan to combine their generic pharmaceuticals businesses and Endo's sterile injectables business after the close of the transaction and intend to separate that business from the combined company at a later date. Such a separation would be subject to approval by the combined company's Board of Directors and other conditions...The combined company's brands portfolio will comprise leading pharmaceutical brands across a range of therapeutic areas, including XIAFLEX (collagenase clostridium histolyticum), Acthar Gel (repository corticotropin injection), Terlivaz (terlipressin), SUPPRELIN LA (histrelin acetate) and AVEED (testosterone undecanoate)."

M&A • Ankylosing Spondylitis • Diabetic Nephropathy • Fibrosis • Immunology • Lupus • Multiple Sclerosis • Ocular Inflammation • Prostate Cancer • Psoriatic Arthritis • Renal Disease • Rheumatoid Arthritis • Sarcoidosis • Systemic Lupus Erythematosus • Uterine Leiomyoma

Endo Reports Fourth-Quarter and Full-Year 2024 Financial Results (Canada Newswire) - "XIAFLEX hit record revenues of $516 million in 2024, up 9% versus 2023."

Commercial • Fibrosis • Immunology • Uterine Leiomyoma • Women's Health

Endo Announces Peyronie’s Disease Presentation at the Annual Meeting of the Southeastern Section of the American Urological Association (PRNewswire) - "Endo, Inc...announced today that a post hoc data analysis of a Phase 3 clinical trial of XIAFLEX (collagenase clostridium histolyticum, or CCH) in patients with Peyronie's disease (PD) will be shared during the 89th annual meeting of the Southeastern Section of the American Urological Association (SESAUA), taking place March 12-15, 2025."

Retrospective data • Sexual Disorders

Clinical Effectiveness of Splinting After Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture (AAOS 2025) - "Our study suggests greater benefit of night orthosis for PI P joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures."

Clinical • Mood Disorders

Dupuytren's Contracture Interventions in the Medicare Population: A Ten-Year Analysis (AAOS 2025) - "There was a moderate increase in DC treatments within the Medicare population, with open fasciectomy remaining the most common intervention. Despite being discontinued elsewhere, collagenase clostridium histolyticum use drastically increased in the US. Additionally, there was a shift from hospital settings to clinics and offices, reflecting a trend towards more outpatient care."

Clinical • Medicare • Reimbursement • US reimbursement • Orthopedics

Analyzing the Impact of Collagenase Clostridium Histolyticum on Treatment Patterns and Social Deprivation Trends in Dupuytren's Contracture (AAOS 2025) - "Across different levels of social deprivation from 2013 to 2021, there was a notable variation in the utilizatio n patterns of treatments for Dupuytren's contracture, particularly an increase in fasciectomy use in communities with low social deprivation. This difference in practice among surgeons likely depended on several factors, some may include the socioeconomic status of patients and the available resources within the practice's zip code area. Previous literature analyzing provider trends before 2015 speculated that CCH would surpass surgical fasciectomy in utilization (Thayer et al., 2018)."

Clinical Effectiveness of an Orthosis After Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture. (PubMed, J Hand Surg Am) - "Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures."

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