Elsevier

The Journal of Hand Surgery

Volume 44, Issue 8, August 2019, Pages 694.e1-694.e5
The Journal of Hand Surgery

Scientific article
Durability of Collagenase Treatment for Dupuytren Disease of the Thumb and First Web After at Least 2 Years’ Follow-Up

https://doi.org/10.1016/j.jhsa.2018.10.002Get rights and content

Purpose

The aim of this study was to analyze the durability of the treatment results of the thumb and first web contractures in Dupuytren disease with collagenase Clostridium histolyticum.

Methods

Twelve patients (14 hands) were followed for an average of 35 months (range, 24–42 months). Two patients (3 hands) were excluded, yielding 11 hands available for assessment. Nondurability was defined as a worsening of at least 20° of passive extension deficit at a treated joint or any decrease greater than 5 mm in intermetacarpal head distance, both relative to 30 days after injection or as intervention to correct new/worsening contracture. Durability was compared with that of a historic cohort of treated finger contractures.

Results

Five out of 11 patients with a metacarpophalangeal or interphalangeal joint contracture or first web contracture had a nondurable result at an average of 35 months. Results obtained at metacarpophalangeal joints of thumbs were more durable than those of interphalangeal joints. Most of the recurrences occurred in interphalangeal joints.

Conclusions

Treatment of thumb and first web contractures was not durable in nearly half of the cases at an average follow-up of 35 months, and durability was clearly less than that of treated finger contractures.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Material and Methods

All 12 patients with 14 hands who previously participated in the efficacy study of CCH in thumb and first web contractures13 were approached an average of 35 months (range, 24–40 months) after their initial CCH treatment and asked to participate in this follow-up study. The local Medical Ethics Committee approved the study. The study was conducted according to the principles of the Declaration of Helsinki and in accordance with the Medical Research Involving Human Subjects Act (Wet Mensgebonden

Results

Eleven patients with DD on the radial side of their hands were available for this follow-up study (11 out of 12 patients). The included patients had a mean age of 64 years (± SD, 4.4) and 8 of them were men. Eight out of the 11 patients were treated in the left hand. All patients had the disease in both hands and all hands except 1 had been treated previously for DD located elsewhere in the hand, reflecting the severity of the disease in these patients. In addition, 5 patients also had

Discussion

In this follow-up study, we found that the effect of the treatment with CCH in first web contractures (IMDs) continued to be stable in most cases at a mean follow-up of 35 months after treatment. However, overall, we saw a deterioration of PED at MCP joints and IP joints, with a better durability for MCP joints than for IP joints. Notwithstanding this, 5 out of 11 patients (1 at the treated MCP joint, 3 at the treated IP joints, and 1 at the treated first web) met the definition of recurrence

Acknowledgment

We thank D. Broekstra MSc, PhD, who trained the investigator to properly use the goniometer to maximize interobserver agreement. Furthermore, we thank her for assisting with statistical analysis.

References (26)

Cited by (2)

  • Dupuytren Contractures: An Update of Recent Literature

    2021, Journal of Hand Surgery
    Citation Excerpt :

    A recent study demonstrated that practitioners may administer the full content of the vial, as much as 0.8 mg per vial or a total of 1.6 mg for multiple digits, in a single visit without a significant increase in severe complications.24 Recent studies have also demonstrated the safety and efficacy of CCH when used to treat retrovascular cords, cords involving the thumb and first webspace, and recurrent disease.27–31 Rates of initial correction following collagenase are similar to those following NA.

During the course of the study, P.M.N.W was a member of the advisory boards of Pfizer Lts and Sobi Ltd. At present he is on the scientific advisory board of Fidia Pharma (Milan, Italy). The Department of Plastic Surgery at University Medical Centre Groningen receives his honorarium, which is used for research purposes and he is reimbursed for his travel costs. The rest of the authors declare that they have no relevant conflicts of interest.

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