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Collagenase injections improved function in patients with Dupuytren’s contractures

Issue: Issue 4 2011

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COPENHAGEN — Patients at 20 European and Australian centers treated with one or more collagenase injections for correction of Dupuytren’s contracture of the metacarpophalangeal or proximal interphalangeal joints had a 76% chance of improved hand function, according to a study presented at the 12th EFORT Congress 2011.

“I think for most of us, this stacks up extremely well against the results of surgery,” consultant hand surgeon Chris Bainbridge, FRCS, of Derby, United Kingdom, said in his presentation.

For his study, Bainbridge and colleagues assessed the efficacy and tolerability of the injection during a 9-month open label trial meant to mimic clinical practice. The study’s primary endpoint was to reduce the treated contractures to less than 5º within 30 days post-treatment, he said. The investigation used the same protocol – up to five injections of the enzyme collagenase clostridium histolyticum (CCH) – as the randomized controlled trials conducted to clear the drug in Europe and the United States.

Overall, patients required about 1.3 injections, Bainbridge said.

“Most patients were rated by their treating physician as improved and as having less severe problems,” he said.

Bainbridge said 98% of study participants reported more than one adverse event; 75% developed a small amount of edema in their hands. The study showed 10% of patients had serious adverse events including a deep venous thrombosis deemed related to the injections and a partial tendon/ligament injury.

Reference:

• Bainbridge C, Houston A,, Jones G, et al. Efficacy and tolerability of collagenase clostridium histolyticum (CCH) in patients with Dupuytren’s contracture (DC): results from a multicenter, open-label study. Paper #2630. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.
• Disclosure: The study was funded by Auxilium Pharmaceuticals Inc.

This treatment is a new and very interesting modality which could be one way of treating patients with Dupuytren’s contracture under regulated conditions where you know exactly how to do the treatment, and who should and should not be treated.

Although it has been stated to be a simple injection, it is not a simple injection. The risk is that if it is released in the hands of non-hand surgeons, as well as I can see, it may be risky because you need to make the injection very precisely. You need to know the exact anatomy and how the injections should be performed. Also, you need to know what complications can develop and, if they develop, how to handle them. This is a really promising treatment but, as I see it, it should be kept in the hands of the experienced person, and this is the hand surgeon.

— Per Kjaersgaard-Andersen, MD
Chief Medical Editor, Orthopaedics Today Europe
Disclosure: Kjaersgaard-Andersen is a member of Pfizer’s advisory board.

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