Follow-up Studies, Satisfaction, Recurrence, Dosage and Drug Safety
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Since CCH was approved by regulatory authorities, further data have emerged. CCH is, in the short term, effective in reducing cord contracture. Higher doses reduce the need for multiple injections on separate occasions but at the expense of increased skin splitting. Local anaesthetic prior to manipulation improves correction but increases the risk of skin splitting. Delayed manipulation allows more convenient scheduling. The relatively high risk of recurrence must be factored into a treatment algorithm. Patient satisfaction is high but may decline with time as the disease recurs. Side effects are common and occasionally alarming, but most are mild and resolve promptly. Clinically significant complications (allergic shock, tendon rupture) are rare. Further comparative information is required for efficacy, cost-effectiveness, satisfaction and recurrence. Because CCH is not suitable for all cords, randomised trials will be of limited value, and registry data are likely to be informative.
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