Clostridium histolyticum as first-line treatment of Dupuytren's disease.

Abstract

INTRODUCTION:

The optimal minimal invasive treatment for Dupuytren's contractures (DC) remains debated. The aim of this study was to evaluate the effect of Clostridium histo-lyticum collagenase after 1-4 years of follow-up. The out-comes of this study were 1) overall improvements in degrees from baseline to follow-up; 2) contraction recurrence defined as an extension deficit above 20°, and 3) Hurst endpoint defined as an extension deficit below 5°.

METHODS:

All patients treated with C. histolyticum collagen-ase at the Regional Hospital Horsens from 2013 to 2016 with a minimum of one year of follow-up due to DC were included. The range of motion of the affected finger joint was measured before and immediately after injection and at follow-up. Specific information regarding known co-morbidities to DC was acquired.

RESULTS:

A total of 112 metacarpophalangeal (MCP) and 47 proximal interphalangeal (PIP) joints were included. Total improvement in the range of motion for MCP and PIP joints were 43° and 16°, respectively. The recurrence rate was 9% for MCP joints and 70% for PIP joints. 73% of MCP joints and 9% of PIP joints achieved the Hurst endpoint. 92% of the patients were willing to repeat treatment.

CONCLUSIONS:

Collagenase is a viable first-line treatment for MCP joint contractures. However, results are inferior in the PIP joint.

FUNDING:

This work was supported by the The Scientific Foundation of Horsens Regional Hospital (grant number 00.06-G01-1-17).

TRIAL REGISTRATION:

ClinicalTrials ID NCT03331926.

• Authors: Charlotte Hartig-Andreasen, Lena Schroll, Jeppe Lange
• Journal: Danish medical journal (Dan Med J) Vol. 66 Issue 2 (Feb 2019) ISSN: 2245-1919 [Electronic] Denmark
• PMID: 30722822 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Chemical References

• Microbial Collagenase

Topics

• Adult
• Dupuytren Contracture (drug therapy, physiopathology)
• Female
• Finger Joint (physiopathology)
• Follow-Up Studies
• Humans
• Injections, Intra-Articular
• Male
• Metacarpophalangeal Joint (physiopathology)
• Microbial Collagenase (therapeutic use)
• Range of Motion, Articular (drug effects)
• Recurrence
• Regression Analysis
• Time Factors
• Treatment Outcome