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Comparative Effectiveness of Collagenase Injection for Dupuytren Contracture

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Dupuytren Disease and Related Diseases - The Cutting Edge

Abstract

Introduction

Questions persist regarding the relative effectiveness of injectable collagenase (CCH) in the treatment of Dupuytren contracture. This study assessed the effectiveness of CCH as compared with limited fasciectomy (LF) in clinical practice.

Methods

We evaluated patients who underwent CCH or LF for metacarpophalangeal (MP) and/or proximal interphalangeal (PIP) joint contractures between 2011 and 2014 at 7 practice sites. We compared the degree of residual contracture (active extension deficit), Michigan Hand Questionnaire (MHQ) scores, and adverse events at follow-up visits occurring between 6 and 12 weeks after surgery or the last injection after matching patients based on their individual propensity scores.

Results

An analysis of 132 matched patients undergoing CCH (N = 66) or LF (N = 66) showed that the degree of residual contracture for affected MP joints was not significantly different at follow-up (13° vs. 6°, P = 0.095). Affected PIP joints, however, showed worse residual contracture after CCH than after LF (25° vs. 15°, P = 0.010). CCH patients experienced fewer serious adverse events than did LF patients and reported larger improvements in the MHQ subscores of satisfaction, activities in daily life, and work performance.

Conclusions

CCH provides an alternative to LF for patients with MP contractures and those with affected PIP joints who are willing to trade slightly better contracture correction for faster recovery of hand function and a lower risk of serious adverse events.

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Conflicts of Interest Declaration

We declare that several coauthors (S.E.R.H., R.W.S., R.F.) have been consultants to Pfizer and Sobi, two manufacturers of injectable collagenase in Europe, after agreeing not to personally receive any form of financial compensation for their advisory services. Support was received from Pfizer in the form that the injections used in the present study were provided free of charge. To ensure objectivity, the present study was conducted without any involvement from both pharmaceutical companies.

This chapter is an extended and updated version of the paper Zhou C et al. (2015) Collagenase Clostridium Histolyticum versus Limited Fasciectomy for Dupuytren’s Contracture: Outcomes from a Multicenter Propensity Score Matched Study. Plast reconstr surg 136:87–97 and is reproduced with permission of the American Plastic Surgery Society and Wolter Kluwer.

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands

    Chao Zhou, Harm P. Slijper & Reinier Feitz

  2. Hand and Wrist Surgery, Xpert Clinic, Hilversum, The Netherlands

    Chao Zhou

  3. Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands

    Steven E. R. Hovius, Christianne A. Van Nieuwenhoven, Hanneke J. Pieters & Ruud W. Selles

  4. Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands

    Ruud W. Selles

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  1. Chao Zhou
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  2. Steven E. R. Hovius
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  3. Harm P. Slijper
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  4. Reinier Feitz
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  5. Christianne A. Van Nieuwenhoven
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  6. Hanneke J. Pieters
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  7. Ruud W. Selles
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Corresponding author

Correspondence to Chao Zhou .

Editor information

Editors and Affiliations

  1. University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Paul M. N. Werker

  2. Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom

    Joseph Dias

  3. Dupuytren Foundation, West Palm Beach, Florida, USA

    Charles Eaton

  4. Nürnberg Clinics, Paracelsus Medical University, Nürnberg, Germany

    Bert Reichert

  5. International Dupuytren Society, Ãœbersee, Germany

    Wolfgang Wach

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Zhou, C. et al. (2017). Comparative Effectiveness of Collagenase Injection for Dupuytren Contracture. In: Werker, P., Dias, J., Eaton, C., Reichert, B., Wach, W. (eds) Dupuytren Disease and Related Diseases - The Cutting Edge. Springer, Cham. https://doi.org/10.1007/978-3-319-32199-8_35

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  • DOI: https://doi.org/10.1007/978-3-319-32199-8_35

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32197-4

  • Online ISBN: 978-3-319-32199-8

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