Interferon (IFN) for Treatment of Peyronie’s disease: Intralesional injections

Peyronie’s disease is characterized by fibrotic scarring or plaque formation over tunica albuginea. Its occurrence is related to presumed repeated microtrauma that results in inflammation and healing by fibrosis. Some men are genetically predisposed to maladaptive fibrotic healing response.  This plaque is made of collagen and affects the erectile capacity of the penis and coital function. It may result in significant psychological stress and marital discord. It affects the quality of life of the patient as well as the partner.

Localized fibrotic scarring results in abnormal curvature of penis, pain during an erection and erectile dysfunction. A nodule is often felt over the upper surface or dorsum of shaft. Though there is no definitive treatment, there are many options which can provide symptomatic relief and delay the progression of inflammatory scarring.

The diagnosis of Peyronie’s disease is simple and based on history and examination. An ultrasound of penis may be performed for exact localization of the plaque.

The options for management include spontaneous resolution, drug therapy and surgery. Observation may be indicated in men with mild curvature of penis less than 30° as it usually allows successful penetration during sexual intercourse. Spontaneous resolution occurs in mild cases over a period of 1 to 2 years, though it is seen in less than 13% of men. Therefore, majority of men require some form of therapy. The drug therapy includes both oral and intra-lesional agents.

Intralesional injection of interferon is a safe method.  It is usually performed by a trained urologist. Usually this is well tolerated by the patients.

There are three types of interferon, alpha, beta and gamma. The alpha interferon is used in the treatment of Peyronie’s disease.

Alpha interferon is a type of protein that prevents fibrosis due to inhibition of fibroblast cell function. It also increases breakdown of collagen by increasing the activity of enzyme collagenase. It also reduces production of collagen, fibronectin and glycosaminoglycans.

The procedure is performed under penile block. The nerves supplying the penis are numbed by injecting a local anaesthetic such as Lidocaine. This allows multiple intralesional injections to be made and also provides post-procedure pain relief. After injection, a compression wrap is applied over penile shaft to prevent leakage of the injected drug. This therapy is given once every 2 weeks and may continue for a period of 6 months.

Intra-lesional injection results in high concentration of drug availability at the site of inflammation to provide maximal benefit. It results in significant reduction in penile curvature, reduction of pain during an erection and resolution or reduction of the plaque.

Research evidence shows that alpha interferon is effective in mild to moderate cases. The side effects are uncommon and may present with flu like symptoms in some people. Other less common side effects include hematoma, swelling, cyst formation and venous leakage.

This treatment is expensive which may limit its utilization.

References:

1. Lacy GL 2nd, Adams DM, Hellstrom WJ. Intralesional interferon-alpha-2b for the treatment of Peyronie’s disease. Int J Impot Res. 2002 Oct;14(5):336-9.

2. Russell S, Steers W, McVary KT: Systematic evidence-based analysis of plaque injection therapy for Peyronie’s disease. Eur. Urol.51(3),640–647 (2007).

3. Hellstrom WJ, Kendirci M, Matern R, Cockerham Y, Myers L, Sikka SC, Venable D, Honig S, McCullough A, Hakim LS, Nehra A, Templeton LE, Pryor JL. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon alpha-2B for minimally invasive treatment for Peyronie’s disease. J Urol. 2006 Jul;176(1):394-8.

Last modified on November 30, 2013