Short-term efficacy and adverse effects of collagenase clostridium histolyticum injections, percutaneous needle fasciotomy and limited fasciectomy in the treatment of Dupuytren’s contracture: a network meta-analysis of randomized controlled trials

Abstract

Aims Dupuytren’s contracture (DC) is a chronic debilitating fibroproliferative disorder. Common treatment options include collagenase clostridium histolyticum injections (CI), percutaneous needle fasciotomy (NF) and limited fasciectomy (LF). Superiority of one specific treatment remains controversial. This study aims to assess the short-term efficacy and safety of CI, NF, and LF for the treatment of DC. Methods We included randomized controlled trials of CI compared with placebo, NF and LF for patients with DC. PubMed, Embase and the Cochrane Library were searched from inception to August 2021. Contracture reduction rates in treated joints (within 0–5° of full extension within 30 days), relative reduction in total passive extension deficit (TPED), occurrence of one or more adverse events and number of treatment-related adverse events per patient were the outcomes of interest. The Cochrane risk-of-bias tool was employed for quality assessment of the studies. A network meta-analysis was performed using MetaXL. Results Nine studies met our inclusion criteria (n = 903). Overall, risk bias was mixed and mostly low. Short term TPED reduction achieved with LF was superior compared to CI and NF. Although CI achieved greater TPED reduction compared to NF, it was associated with the highest risk of overall adverse effects. The analyzed data was limited to a maximum three-year follow-up period and therefore insufficient for long-term outcome evaluation. Conclusions In DC, LF may be able to provide patients with severe disease, superior flexion contracture release postoperatively. CI is a valid treatment alternative to NF, however the higher risk of overall adverse effects must be considered. The quality-of-evidence is limited due to short-term follow-up periods and a lack of standardized definitions of complications and adverse events.

Dupuytren’s contracture treated with collagenase Clostridium histolyticum

“…The effectiveness in restoring the functional capabilities of the hand was approximately the same for all methods. Similar findings were obtained in a more recent meta-analysis by D. Obed et al [15]. They also indicated a higher incidence of complications after the use of Clostridium histolyticum collagenase preparations compared to percutaneous needle aponeurotomy, although they did not investigate this in comparison with open fasciectomy.…”

Comparing Collagenase and Tissue Subcision for Cellulite Treatment of the Buttock and Thigh Regions: A Systematic Review and Meta-analysis

“…Other modalities used in the treatment of cellulite, as well as other aesthetic targets treated with subcision or CCH collagenase (atrophic scars, Duputryen, and Peyronie contracture), seem to be facing similar difficulties in terms of the reporting quality and finding a unifying measure to assess the outcome. [36][37][38][39][40][41] Turati et al 36 criticized the lack of appropriate reporting regarding the sample size calculations, statistical methods, the number of participants, and their characteristics. Nevertheless, they evaluated the efficacy of cosmetic products on cellulite by evaluating the thigh circumference change.…”

“…37 Meta-analyses repeatedly pointed to the heterogeneity of outcomes, leading to the inability of direct comparisons among the studies, or preventing the investigators from conducting more robust analyses and drawing more reliable conclusions due to a low count of studies that could be included in the quantitative synthesis. [36][37][38][39][40][41]…”

Dupuytrenova kontraktura - bolest Vikinga u suvremenom svijetu

“…Metaanaliza Obeda i sur. 2022. dovela je do zaključka da je djelomična fasciektomija bolja opcija za pacijente sa značajnijom kontrakturom, rezultirajući manjim konačnim de- ficitom ekstenzije uz više ozbiljnih komplikacija, dok se tretman kolagenazom pokazao dobrom alternativom PFI-ju kod manjih kontraktura, iako sa značajno više ukupnih komplikacija od PFI-ja 68 . Trenutno su u provedbi istraživanja (studija DE-TECT, studija DISC) koja procjenjuju i uspoređuju dugoročnu korist liječenja, efikasnost i isplativost ove terapije s obzirom na cijenu i veliki postotak komplikacija i recidiva.…”