Abstract：
BACKGROUND: Peyronie\'s disease (PD) is a common penile disorder characterized by the formation of fibrous noncompliant hard nodules in the tunica albuginea of the penis. Collagenase Clostridium histolyticum (CCH) is an injectable drug that treats PD by enzymatically degrading plaque interstitial collagen. CCH has been used in patients with varying curvature, as well as in the acute and stable phases of the disease, through a variety of treatment regimens and combinations. We carried out a systematic review and meta-analysis to assess the efficacy of CCH combination therapies for PD.
METHODS: We selected 4 observational comparative studies and 3 randomized controlled trials including 532 participants from the PubMed, Embase, and Cochrane databases (until December 2023) to evaluate the efficacy of CCH combination therapies for PD. The primary outcome was clinical efficacy as evaluated by improvement in penile curvature and penile length, as well as by scores on the Peyronie\'s Disease Questionnaire (PDQ) for symptom bother, penile pain, and psychological symptoms. Continuous data were represented by mean difference (MD) and 95% CI. All data were analyzed by Review Manager version 5.3.
RESULTS: For penile length (MD, 0.81 cm; 95% CI, 0.17-1.45; P = .01), PDQ symptom bother (MD, -1.02; 95% CI, -1.83 to -0.21; P = .01), and PDQ penile pain (MD, -0.93; 95% CI, -1.50 to -0.36; P = .001), CCH combination therapy showed significantly greater improvements vs CCH monotherapy. However, in the other indicators, penile curvature and PDQ psychological symptoms, there was no significant difference between the therapies.
CONCLUSIONS: This meta-analysis supports that CCH combination therapies can partially increase penile length and ameliorate symptom bother and penile pain to some extent. However, CCH combination therapies still need to be evaluated through more high-quality research.
METHODS: We selected 4 observational comparative studies and 3 randomized controlled trials including 532 participants from the PubMed, Embase, and Cochrane databases (until December 2023) to evaluate the efficacy of CCH combination therapies for PD. The primary outcome was clinical efficacy as evaluated by improvement in penile curvature and penile length, as well as by scores on the Peyronie\'s Disease Questionnaire (PDQ) for symptom bother, penile pain, and psychological symptoms. Continuous data were represented by mean difference (MD) and 95% CI. All data were analyzed by Review Manager version 5.3.
RESULTS: For penile length (MD, 0.81 cm; 95% CI, 0.17-1.45; P = .01), PDQ symptom bother (MD, -1.02; 95% CI, -1.83 to -0.21; P = .01), and PDQ penile pain (MD, -0.93; 95% CI, -1.50 to -0.36; P = .001), CCH combination therapy showed significantly greater improvements vs CCH monotherapy. However, in the other indicators, penile curvature and PDQ psychological symptoms, there was no significant difference between the therapies.
CONCLUSIONS: This meta-analysis supports that CCH combination therapies can partially increase penile length and ameliorate symptom bother and penile pain to some extent. However, CCH combination therapies still need to be evaluated through more high-quality research.
摘要：
背景：Peyronie病（PD）是一种常见的阴茎疾病，其特征是在阴茎白膜中形成纤维性非顺应性硬结节。胶原酶溶组织梭状芽孢杆菌（CCH）是一种可注射药物，通过酶促降解斑块间质胶原来治疗PD。CCH已用于不同曲率的患者，以及在疾病的急性和稳定阶段，通过各种治疗方案和组合。我们进行了系统评价和荟萃分析，以评估CCH联合治疗PD的疗效。
方法：我们选择了4项观察性比较研究和3项随机对照试验，包括来自PubMed的532名参与者，Embase,和Cochrane数据库（至2023年12月），以评估CCH联合疗法对PD的疗效。主要结果是通过改善阴茎弯曲和阴茎长度来评估临床疗效。以及Peyronie疾病问卷（PDQ）上关于症状困扰的分数，阴茎疼痛,和心理症状。连续数据用平均差(MD)和95%CI表示。所有数据均通过ReviewManager版本5.3进行分析。
结果：对于阴茎长度（MD，0.81厘米；95%CI，0.17-1.45；P=0.01），PDQ症状困扰(MD，-1.02；95%CI，-1.83至-0.21；P=0.01），和PDQ阴茎疼痛(MD，-0.93；95%CI，-1.50至-0.36；P=.001），与CCH单药治疗相比，CCH联合治疗显示出明显更大的改善。然而,在其他指标中，阴茎弯曲和PDQ心理症状，两种疗法之间没有显著差异.
结论：这项荟萃分析支持CCH联合治疗可以部分增加阴茎长度，并在一定程度上改善症状困扰和阴茎疼痛。然而,CCH联合疗法仍需要通过更多高质量的研究来评估。
方法：我们选择了4项观察性比较研究和3项随机对照试验，包括来自PubMed的532名参与者，Embase,和Cochrane数据库（至2023年12月），以评估CCH联合疗法对PD的疗效。主要结果是通过改善阴茎弯曲和阴茎长度来评估临床疗效。以及Peyronie疾病问卷（PDQ）上关于症状困扰的分数，阴茎疼痛,和心理症状。连续数据用平均差(MD)和95%CI表示。所有数据均通过ReviewManager版本5.3进行分析。
结果：对于阴茎长度（MD，0.81厘米；95%CI，0.17-1.45；P=0.01），PDQ症状困扰(MD，-1.02；95%CI，-1.83至-0.21；P=0.01），和PDQ阴茎疼痛(MD，-0.93；95%CI，-1.50至-0.36；P=.001），与CCH单药治疗相比，CCH联合治疗显示出明显更大的改善。然而,在其他指标中，阴茎弯曲和PDQ心理症状，两种疗法之间没有显著差异.
结论：这项荟萃分析支持CCH联合治疗可以部分增加阴茎长度，并在一定程度上改善症状困扰和阴茎疼痛。然而,CCH联合疗法仍需要通过更多高质量的研究来评估。
