Topical verapamil HCl, topical trifluoperazine, and topical magnesium sulfate for the treatment of Peyronie's Disease - A Placebo-Controlled Pilot Study

Introduction: Transdermal and intralesional verapamil has been reported to be useful in the treatment of Peyronie's Disease. This study evaluates a topically applied calcium channel blocker (verapamil hydrochloride 15% gel), a topically applied calmodulin blocker (trifluoperazine), and a topically applied weak calcium channel blocker (magnesium sulfate), each incorporated in a transdermal vehicle. Aim: This pilot study was conducted to assess the efficacy of a 15% verapamil gel applied topically to the penile shaft twice daily for the treatment of Peyronie's Disease. Main Outcome Measure: To assess improvement in curvature, plaque size, resolution of painful erections, and improvement in erection quality. Methods: Two simultaneous, three armed, double blinded, placebo-controlled studies were conducted. After randomization into one of four groups, patients were treated for 3months. At the end of 3months' treatment using blinded drug, each patient was treated with open label topical verapamil for 6months. The studies were completed after each patient had been treated and evaluated for 9months after randomization. Results: Fifty-seven patients were randomized. In total, 94.4% of patients treated for 9months with topical verapamil experienced improvement in curvature with an average percent curvature change of 61.1% compared with 43.6% curvature improvement at 3months. At 9months the average percent plaque change was 84.7% compared with 55% at 3months. Pain resolution at 9months was 100% compared with 87.5% at 3months. Patient perception of erection quality also increased at 9months to 81.8% compared with 72.7% at 3months. Conclusions: Topical verapamil gel proved effective in eliminating pain on erection, decreasing the size of plaque, decreasing curvature, and improving erection quality in patients with Peyronie's Disease. Treatment results improved significantly after 9months' treatment as compared with 3months' treatment.