Dupuytren’s contracture recurs less often with MP joint collagenase injection

Patients with one or more collagenase clostridium histolyticum injections and at least one follow-up examination took part in the prospective study.

Issue: Issue 4 2012

BERLIN — A prospective study of patients with Dupuytren’s contracture whose cords were treated with a collagenase clostridium histolyticum medication approved for use in Europe showed an overall 35% recurrence rate at 3 years in joints initially declared a clinical success.

“Three years of follow-up after initial treatment with CCH, [shows it] is an efficacious and well-tolerated treatment for Dupuytren’s contracture,” Jarkko Vasenius, MD, of Helsinki, one of 39 investigators in the 5-year multicenter trial called CORDLESS, said. “In joints achieving clinical success, recurrence rate was 35% and only 7% of the joints achieving clinical success underwent further intervention.”

Vasenius presented the results at the 13th EFORT Congress 2012. He and his colleagues received the Free Paper Silver Award at the meeting for their work.

This part of the CORDLESS trial involved the evaluation of 1,080 joints in 643 subjects 3 years after treatment; 58% of joints achieved clinical success after initial treatment with CCH. Investigators defined clinical success as a fixed flexion contracture (FFC) reduced to 0° or within 5° of normal.

Measurable improvement was defined as “when FFC was reduced 20° or more from the baseline, but not to 5° or less,” Vasenius noted. “All the rest were considered not effectively treated.”

Injecting CCH into proximal interphalangeal (PIP) joints proved less successful at preventing Dupuytren’s contracture recurrence at the site by 3-year follow-up vs. the metacarpophalangeal (MP) joints. Investigators found 56% of patients with PIP injections had a recurrence vs. 27% of patients whose MP joints were treated with CCH.

“MP joints had a slower rate of recurrence than PIP joints after 3 years after CCH injection, and these results are similar to results reported after fasciectomy,” Vasenius said.

Recurrence was defined as increasing contracture in the treated joint of 20· or more in conjunction with palpable cords, or joints that received further medical or surgical interventions. According to Vasenius, “93% of all joints achieving clinical success did not receive any additional surgical or medical intervention by year 3.”

Those studied had a mean pretreatment fixed contracture of 44°.

Among joints in which contracture recurred after CCH injection by year 3, none reached the pretreatment FFC level, according to the results. In MP joints that had a recurrence, the mean pretreatment FFC was 36.5°, which reached 32.8° mean after treatment. In PIP joints that had recurrence, the mean pretreatment FFC was 40.1°, which reached 36.7° mean after treatment.

“No new long-term or serious adverse events were identified and attributed to CCH during the 3-year follow-up,” Vasenius said. – by Susan M. Rapp

Reference:

Berber R, Boyce D, Boeckstyns M, et al. Three-year recurrence rates of Dupuytren’s contracture following successful collagenase clostridium histolyticum treatment. Paper #F12-1711. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.

For more information:

Jarkko Vasenius, MD, can be reached at Dextra Hand Clinic, Raumantie 1 A, Helsinki, Finland; email: jarkko.vasenius@dextra.fi.
Disclosure: Vasenius is a shareholder of Orion Ltd., an employee of Pronator Oy and Dextra Hand Clinic, a consultant for Pfizer, and a paid instructor for Pfizer, Synthes. He is on the speaker’s bureau for Synthes and Acumed (Summed Finland).