Journal of Hand Surgery
Volume 35, Issue 4 , Pages 534-539.e1, April 2010

Collagenase Injection as Nonsurgical Treatment of Dupuytren's Disease: 8-Year Follow-Up

  • Andrew J. Watt, MD

      Affiliations

    • Corresponding Author InformationCorresponding author: Andrew J. Watt, MD, Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University Hospitals & Clinics, 770 Welch Road, Suite 400, Palo Alto, CA 94304
    • ,
  • Catherine M. Curtin, MD
    • ,
  • Vincent R. Hentz, MD

Department of Surgery, Stanford University Hospitals and Clinics, Palo Alto, CA

Received 18 November 2009; accepted 6 January 2010.

Purpose

Collagenase has been investigated in phase II and phase III clinical trials for the treatment of Dupuytren's disease. The purpose of this study is to report 8-year follow-up results in a subset of patients who had collagenase injection for the treatment of Dupuytren's contracture.

Methods

Twenty-three patients who participated in the phase II clinical trial of injectable collagenase were contacted by letter and phone. Eight patients were enrolled, completed a Dupuytren's disease questionnaire, and had independent examination of joint motion by a single examiner.

Results

Eight patients completed the 8-year follow-up study: 6 had been treated for isolated metacarpophalangeal (MCP) joint contracture, and 2 had been treated for isolated proximal interphalangeal (PIP) joint contracture. Average preinjection contracture was 57° in the MCP group. Average contracture was 9° at 1 week, 11° at 1 year, and 23° at 8-year follow-up. Four of 6 patients experienced recurrence, and 2 of 6 had no evidence of disease recurrence at 8-year follow-up. Average preinjection contracture was 45° in the PIP group. Average contracture was 8° at 1 weeks, 15° at 1 year, and 60° at 8-year follow-up. Both patients experienced recurrence at 8-year follow-up. No patients had had further intervention on the treated finger in either the MCP or the PIP group. Patients subjectively rated the overall clinical success at 60%, and 88% of patients stated that they would pursue further injection for the treatment of their recurrent or progressive Dupuytren's disease.

Conclusions

Enzymatic fasciotomy is safe and efficacious, with initial response to injection resulting in reduction of joint contracture to within 0°–5° of normal in 72 out of 80 patients. Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. In addition, patient satisfaction was high.

Type of study/level of evidence

Therapeutic IV.

Key words: Collagenase, Dupuytren's contracture, Dupuytren's disease, injectable collagenase

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 C.M.C. received compensation for participation in the phase III clinical trial of injectable collagenase.

 Institutional funding of phase III clinical trials provided by Auxilium. No funding was received by the authors or the institution for the completion of this study. The authors have no financial interest in injectable collagenase or Auxilium. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

PII: S0363-5023(10)00004-3

doi:10.1016/j.jhsa.2010.01.003

Journal of Hand Surgery
Volume 35, Issue 4 , Pages 534-539.e1, April 2010

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