Treatment of Recurrent Dupuytren Contracture in Joints Previously Effectively Treated With Collagenase Clostridium histolyticum.

Abstract

PURPOSE:

Collagenase Clostridium histolyticum (CCH) is approved for the treatment of adults with Dupuytren contracture with a palpable cord. This open-label, phase 4 study evaluated the safety and efficacy of CCH for the retreatment of recurrent contractures in joints that were previously effectively treated with CCH.

METHODS:

Patients participating in a long-term follow-up study who had contracture recurrence (increased ≥ 20° with a palpable cord) after successful treatment in the previous study were eligible. Recurrent joint contractures were treated with up to 3 CCH injections (∼ 1 month apart). Patients were followed for 1 year to evaluate safety. Assessments included change in joint contracture, range of motion, and the percentage of joints that achieved contracture of 5° or less at day 30 after the last injection.

RESULTS:

The efficacy analysis included 51 patients with 1 treated joint per patient (31 metacarpophalangeal, 20 proximal interphalangeal). A total of 35 joints (69%) received 1 injection, 12 (24%) received 2 injections, and 4 (8%) received 3 injections. Fifty-seven percent of joints achieved contracture of 5° or less (29 of 51). Overall, 86% (43 of 50) patients had a 20° or greater increase in range of motion. The adverse event profile was consistent with previous studies. One ligament injury was reported.

CONCLUSIONS:

At a short-term follow-up of 1 year, recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic IV.

• Authors: Brian J Bear, Clayton A Peimer, F Thomas D Kaplan, Gregory J Kaufman, James P Tursi, Ted Smith
• Journal: The Journal of hand surgery (J Hand Surg Am) Vol. 42 Issue 5 Pg. 391.e1-391.e8 (May 2017) ISSN: 1531-6564 [Electronic] United States
• PMID: 28341067 (Publication Type: Clinical Trial, Phase IV, Journal Article, Multicenter Study)
• Copyright: Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Chemical References

• Microbial Collagenase

Topics

• Aged
• Dupuytren Contracture (drug therapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Microbial Collagenase (therapeutic use)
• Middle Aged
• Range of Motion, Articular
• Recurrence
• Retreatment
• Treatment Outcome