Collagenase injections for Dupuytren's contracture: prospective cohort study in a public health setting.

Abstract

BACKGROUND:

Dupuytren's disease causes a flexion contracture of the hand that limits hand function and reduces quality of life. Traditional management is surgical excision which is associated with potentially serious complications. A viable alternative is collagenase Clostridium histolyticum (CCH) (Xiaflex®; Pfizer Australia) which is an effective, safe, outpatient treatment that to date has no published data in the Australian public health setting.

METHODS:

A prospective cohort, single centre study, enrolling 54 patients to treat 81 joints with CCH. Patients received a single dose to the cord followed by joint manipulation 48 h later. Primary endpoint was reduction in contracture to 0 to 5° of full extension assessed 4 weeks after injection. Secondary endpoints included range of motion, patient satisfaction and function as measured by the Southampton Dupuytren's Scoring Scheme (SDSS).

RESULTS:

Primary endpoint was achieved in 48% of joints (66% metacarpophalangeal and 19% proximal interphalangeal). Mean flexion contracture improved by 40o and 25o for metacarpophalangeal and proximal interphalangeal joints, respectively. Mean active range of motion improved by 39o and 18o , respectively. At 30 days and 12 months, SDSS score demonstrated sustained improvement versus baseline (1.88 versus 8.24 P ≤ 0.0005 and 1.59 versus 8.07 P ≤ 0.0005). Sixty-eight percent of patients were either very satisfied or satisfied at 12-month follow-up. Side effects of treatment were minor; with oedema and bruising the most common (87% and 85%, respectively).

CONCLUSION:

CCH injections are a viable treatment for Dupuytren's contracture in the Australian public health setting.

• Authors: Jason Fletcher, Ezekiel S L Tan, Michael Thomas, Fraser Taylor, Devlin Elliott, Randy Bindra
• Journal: ANZ journal of surgery (ANZ J Surg) Vol. 89 Issue 5 Pg. 573-577 (05 2019) ISSN: 1445-2197 [Electronic] Australia
• PMID: 30685881 (Publication Type: Journal Article)
• Copyright: © 2019 Royal Australasian College of Surgeons.

Chemical References

• Collagenases

Topics

• Aged
• Collagenases (administration & dosage)
• Dupuytren Contracture (drug therapy, physiopathology)
• Female
• Finger Joint (physiopathology)
• Follow-Up Studies
• Humans
• Injections, Intralesional
• Male
• Patient Satisfaction
• Prospective Studies
• Public Health
• Range of Motion, Articular (physiology)
• Treatment Outcome