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.