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 40 o and 25 o for metacarpophalangeal and proximal interphalangeal joints, respectively. Mean active range of motion improved by 39 o and 18 o , 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.

Report on the Evidence-Based Practice Committee’s Survey on Dupuytren Disease

“… 11 Another study of a prospective cohort of 54 patients documented high risk minor complications of edema and bruising (87% and 85%, respectively) after CI. 12 It should be noted that some of the minor complications that are reported, such as edema and ecchymosis, may be considered by some to be a natural consequence of the procedure, and this should be taken into account when evaluating this evidence.…”

Dupuytren’s disease: using needles more across the world

“…CCH was delivered in 15 public hospitals within Australia, giving all patients with DD access to CCH irrespective of their ability to pay for the drug. CCH was confirmed to be a safe and effective option in Australian public health setting ( Fletcher et al., 2019 ). CCH was also a much less expensive option than LF (Elliot et al., 2019; Sefton et al., 2018).…”

The influence of skin tears following collagenase treatment of Dupuytren’s disease on treatment outcomes

“…Collagenase clostridium histolyticum (CCH) was found to be safe in use and as effective as open procedures in treatment of Dupuytren’s disease, although it is inferior with regards to time to recurrence (Costas et al., 2017; Fletcher et al., 2019; Gilpin et al., 2010; Paynter et al., 2018; Peimer et al., 2015; Warwick et al., 2015; Witthaut et al., 2013). Reported risks are injection pain, inflammation, oedema, lymphadenopathy and flexor tendon rupture.…”