Possible/Future drugs development

[Tim468]

AU Dickstein R.  Uberoi J.  Munarriz R.
FA Dickstein, Rian.  Uberoi, Jayant.  Munarriz, Ricardo.
IN Center for Sexual Medicine, Department of Urology, Boston
 University School of Medicine, Boston, MA 02118, USA.
TI Severe, disabling, and/or chronic penile pain associated with
 Peyronie disease: management with subcutaneous steroid injection.
SO Journal of Andrology.  31(5):445-9, 2010 Sep-Oct.
AB Penile pain is one of the most distressing, limiting, and
 difficult to treat manifestations of Peyronie disease. The use of
 steroid injections for penile deformities associated with Peyronie
 disease has been ineffective. However, use of steroid injections in
 managing penile pain has been poorly investigated. The aim of this
 study was to examine the efficacy and safety of subcutaneous,
 nonintralesional steroid injections in patients with severe,
 disabling, and/or chronic penile pain associated with Peyronie
 disease. This was a single-institution retrospective study of 16
 patients with severe, disabling, and/or chronic penile pain
 associated with Peyronie disease who underwent subcutaneous,
 nonintralesional injection of triamcinolone (50 mg) between 2004 and
 2006. Preinjection and postinjection analog pain scales were used to
 assess treatment efficacy. All 16 patients (mean age, 47.6 +/- 11.1
 years) had penile pain associated with erections for an average of
 13.9 months (range, 3-36 months) prior to injections. Mean
 preinjection and postinjection penile pain scores were 6.6 +/- 2.1
 and 0.5 +/- 0.5, respectively. On average, patients were pain free
 at follow-up visits within 10.6 +/- 7.6 weeks. The mean pain-free
 duration was 23.8 months (range, 3-52 months). The mean cumulative
 dose of triamcinolone was 75.0 mg (range, 50-200 mg), with a mean of
 1.5 injections (range, 1-4 injections). All 16 patients had overall
 improvement in pain scores. There were no adverse events or
 geometric penile changes after injections. Subcutaneous,
 nonintralesional injections of triamcinolone is an effective, safe,
 and durable means of managing severe, disabling, and/or chronic
 penile pain in patients with Peyronie disease. Future studies are
 needed to validate these findings.
PT Journal Article.

[Woodman]

This is interesting, is there anyone here who has any experiance with these injections? I ve had pretty much constant pain going on 4 years with Peyronies and nothing has stopped it completely. From my experiance talking with at least 4 Uros they do not want to confront the subject of pain with Peyronies. In fact you can watch them skate around the subject. I ve also heard other guys mention there experiances to the same effect from there Uros too.

[MikeSmith0]

i had a very small amount of kenalog and there was possibly less pain at the time... but it will come back eventually.  i got a very low dose though.  i think ubiquinol and pentox have worked for people here for pain.

[skunkworks]

http://en.wikipedia.org/wiki/Sulfasalazine

http://www.webmd.com/drugs/drug-63166-Sulfazine+Oral.aspx?drugid=63166&drugname=Sulfazine+Oral

In recent British research involving animal studies, and more recently, human trials for the treatment of chronic alcoholics, sulfasalazine has been found to reverse the scarring associated with cirrhosis of the liver. Cells called myofibroblasts, which contribute to scar tissue in a diseased liver, also appear to secrete proteins that prevent the breakdown of the scar tissue. Sulfasalazine appears to retard this secretion.

[Ben]

Not sure that what can works on the liver tissue can works on penile tissue, but interesting anyway.

[skunkworks]

The idea that there might be a protein being secreted which stops the break down of scar tissue, is one that would bear investigation with regards to peyronies.

[Luciano]

While surfing, I just found a new study (december 2011) of using ilprost injections. Seem to have some promising  results
here the abstract:
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10733.x/abstract

Its only a phase 1 study without placebo group... but I will certainly watch for iloprost in future publications.

Luc

PS:Interesting study but:
In the results is stated: "A total of 29% of the patients showed an improvement in curvature."
No mention regarding how much improvement. If it was a remarkable improvement, I think they was stating that and including a table as many studies are doing.

[james1947]

The study phase I was to test the drug side effects.
It is interesting because they are talking about Peyronie's in stable state and even calcified plaques.
The 29% of the patients curvature improvement is some how disappointing but other injections have better results? I don't know.
Let's hope that in the study phase II they will find the dosage to improve the % and let's hope that it will be soon and not in a few years from now.
James  

[Hermes]

This may become the treatment of the future. Decorin is naturally occurring. So far there's one study on rats with Peyronies Disease with a good outcome but there's also a bit out there on the use of decorin for other purposes .. reduction of fibrosis in other areas. Treatment was by injection for the rats. That may be problematic for the penis as any intrusion is likely to cause more scarring but it may be be a lot better than doing nothing.  There are other ways of delivering drugs or substances that might work .. iontophoresis perhaps.  

[Hermes]

The study on the rats is recent .. June 2012 and can be found here.

http://www.ncbi.nlm.nih.gov/pubmed/22670875

TGF-β is a causative factor in fibrosis and decorin counteracts it.

For a discussion on it in relation to sports injury see:

http://www.sportsinjurybulletin.com/archive/decorin.htm


This is something all urologists should now be looking at. If your urologist doesn't know about it, let him/her know.

[james1947]

Hermes

Many people that have severe ED are treating it with injections. In some cases it makes peyronies worst, some cases starts Peyronies, some cases are  fine.
Regarding iontophoresis, have some discussions under the "Alternative Treatments of Peyronie's Disease" board and other boards, most with very little success or no success at all.

James

[GS]

I found this in a PubMed article.  Has anyone else looked at it?

Peironimev-plus® in the treatment of Chronic Inflammation of Tunica Albuginea ( Peyronie's Disease ). Results of a controlled study.

GS

[james1947]

This what I find in the subject:
Peironimev-plus® in the treatme... [Inflamm Allergy Drug Targets. 2012] - PubMed - NCBI

The trial is very new, most of the articles are in Italian.
This what I get from google translate:
http://translate.google.com/translate?hl=en&sl=it&u=http://prenotazioni.farmaciecoli.it/catalogo/Catalogo-Prodotti/Omeopatia-e-medicina-naturale/Complessi-omeobioterapici/Complessi-omeobioterapici:-compresse/confetti/PEIRONIMEV-PLUS-30CPR/pg/2/c/656/p/41791.html&prev=/search%3Fq%3DPeironimev-plus%25C2%25AE%26start%3D10%26hl%3Den%26sa%3DN%26biw%3D1366%26bih%3D673%26prmd%3Dimvns&sa=X&ei=CT11UL3xMcLZrQesnICYCQ&ved=0CDEQ7gEwAzgK
I don't know if the supplement is available in other place except Italy.
It contain propolis also, we have a topic in the subject.

James

[Jonbinspain]

I found this in English, if it helps.


Peironimev-plus® in the treatment of chronic inflammation of tunica albuginea ( Peyronie's Disease ). Results of a controlled study - Abstract | Peyronie's | UroToday | Urology Information

[Hawk]

Jonbinspain,

That link is not working.

[GS]

Here are the ingredients from the Italian website:

Average content per daily dose
(1 tablet)
Tocopherol (vitamin E) 30 mg
Para-aminobenzoic acid 100 mg
Persea gratissima 50 mg
Liriosma ovata dry extract E / D: 1/4 25 mg
Turnera aphrodisiaca dry extract E / D: 1/4 25 mg

How to use
1 tablet per day. Unless otherwise medical advice. Warnings supplements are not intended as a substitute for a varied diet. Keep out of the reach of children under three years of age. Conservation Store in a cool, dry place. Format 30 tablets of 400 mg.

The main ingredient is PABA at 100mg...


This kind of seems to be more snake oil to me, but the results in the Pub Med article seemed pretty impressive.  Maybe one of our more informed members will check it out.  I found the information online in Italian and Google translated it for me.

GS

[Hawk]

The main ingredient is PABA at 100mg...


This kind of seems to be more snake oil to me, but the results in the Pub Med article seemed pretty impressive.  Maybe one of our more informed members will check it out.  I found the information online in Italian and Google translated it for me.

PubMed i a good source but I think it is sometimes just a case of garbage in and garbage out.  I don't know much about their standards but I suspect they take any studies they are given at face value. I suspect they do not evaluate methodology or integrity of the studies.  That falls on the group conducting the study.

[Jonbinspain]

It seems that the results of this study involve combining it with Verapamil, both injected and trans dermal, as opposed to stand alone Verapamil. If, and of of course it's still a big if, this stuff is any good, maybe it suggests a synergy with Verapamil?

[james1947]

From what I am reading on the forum:
* Not many testimonies of Paba success
* Not many testimonies of VI success
* Not many testimonies of  trans dermal Verapamil success
Maybe the combination of them with the other ingredients of the Peironimev-plus® is helping.
Peironimev-plus® is a food supplement, so every one can try it.

James

[ComeBacKid]

But lots of stories of pentox success.... notice a pattern here?  

[james1947]

The pattern I have noticed is that Pentox has and is helping many, from people's own testimonies, and is more and more recognized by urologists as a 1st line medication for Peyronies.

James

[Iceman]

comebackkid....how many pentox should i be taking a day??
i generally have only 1 in the morning and thats it....
i seem to remember you were taking many per day - is this still the case??

[pless]

how many pentox should i be taking a day??

Two or preferably three 400mg time delay tablets.  Different clinical studies found two and three effective.  But the clinical study that gave two, ends saying: "studies with different treatment regimens (perhaps higher doses with a longer duration) are warranted."

[pless]

Here are the ingredients from the Italian website:
Average content per daily dose
(1 tablet)
...
Para-aminobenzoic acid 100 mg
...

This is a uselessly small amount of POTABA.  The usual dose for Peyronies treatment is 12 grams per day!  There was a well controlled study in 2004 which found some efficacy at that large dose.