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

Collagenase Clostridium histolyticum injections are a viable alternative treatment for Dupuytren's contracture in the Australian public health setting.

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.

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