Purpose
We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord.
We assessed whether more severe contractures respond less well or recur more frequently.
Methods
From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum
1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana
system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received
a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position
was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin
tears, and any adverse events were noted. Recurrence was defined as a failure to maintain
any prior correction to within 20°.
Results
There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected
completely, with approximately half remaining corrected at 1 year. We achieved 43°
(95% confidence interval, 40°–46°) correction of combined deformity, with 11° (95%
confidence interval, 9°–13°) correction attrition over 1 year. Sixteen percent of
treated digits experienced a recurrence with no difference between Tubiana grades,
and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures
improved by 78% in comparison with higher grade contractures (55%–67% relative correction).
By 1 year, all grades had a similar mean 46% relative correction. A complete correction
was seen in 61% of grade 1 contractures, with more severe contractures less likely
to correct completely (9%–24%). A 31% skin tear rate had no impact on outcome, recurrence,
or long-term morbidity.
Conclusions
CCH may treat any Dupuytren cord regardless of severity. Although contracture may
recur, few patients pursue further treatment within 1 year.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: August 27, 2020
Accepted:
June 24,
2020
Received:
May 24,
2019
Footnotes
An educational grant was received from Swedish Orphan Biovitrium AB (SOBi), which was used to fund database setup and support staff to assist with data collection. SOBi were neither involved in the recruitment process of the aforementioned staff nor had access to the data collected for analysis.
M.B. is a paid speaker for Swedish Orphan Biovitrium AB (SOBi), Stockholm, Sweden, and Pfizer, Brooklyn, NY. The rest of the authors declare that they have no relevant conflicts of interest.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
