Early outcomes of a sequential series of 144 patients with Dupuytren’s contracture treated by collagenase injection using an increased dose, multi-cord technique

Abstract

Collagenase clostridium histolyticum is the first and only United States Food and Drug Association approved nonsurgical treatment for patients with a palpable Dupuytren's contracture cord. However, the Food and Drug Association has only approved injection of 0.58 mg of this enzyme into one palpable Dupuytren's contracture cord at a time. This review reports on the early outcome of 144 patients treated with the entire bottle of enzyme, approximately 0.78 mg, along with use of a novel slow intracord multi-cord technique. Use of 0.78 mg of enzyme, with the slow intracord multi-cord technique is safe and allows one to inject multiple Dupuytren's contracture cords at one setting. Correction at metacarpophalangeal and proximal interphalangeal joints, taken individually, are comparable with the Collagenase Option for the Reduction of Dupuytren's studies at 43° and 33°, respectively, however due to the multi-cord injection, we achieved 94° average immediate and 76° average final combined metacarpophalangeal and proximal interphalangeal contracture releases per bottle of enzyme. Implementation of the slow intracord multi-cord technique has the potential to improve current treatment for Dupuytren's contracture with resultant significant healthcare savings.

Efficacy of Collagenase Clostridium Histolyticum for Dupuytren Disease: A Systematic Review

“…9 Warwick 38 performed a series in which results regarding "unusual" cords (natatory, Y-shaped or crow-foot cords) were specified in the same way as Verheyden. 39 Several studies [40][41][42] assessed the impact with respect to the extension time following consistent administration of treatment.…”

“…The measurement of results has mixed values at varying degrees of measuring: a priori 16 articles used the range of movement (ROM) to evaluate results in whole or in part, while the remaining 35 did not use this method, limiting themselves to assessing extension deficit results in degrees by separate joints, groups of joints (passive extension deficit [PED]), or one article even 44 The administered dose was standard in all studies, except for two studies that used double dose on the same hand at a time, 17,46 and four that used the standard dose plus the amount remaining in the vial in various formats. 39,[47][48][49] Twenty-three studies followed an injection protocol in which they allowed one to three infiltrations per joint and patient, four 25,29,38,47 studies used one or two injections, even though they followed the CORD protocols, and presumably if it were needed, they would have used three, and the rest used a protocol of one injection for an infiltration of a joint. In the studies that specified how many vials were used per joint, the mean was 1.23 (range 0.8-1.6; SD: 0.36), with only one study having used less than one vial per joint, 50 and with the studies by Gilpin 14 (1.5) and Sood 30 (1.6) being the ones that used more than one vial per joint.…”

“…56 The bibliography is variable in this regard. Twenty-seven articles refer to the systematic use of this device, 6,14,15,17,20,22,25,26,30,33,35,36,[38][39][40][41]44,[46][47][48][49]51,54,[57][58][59][60] and a multicenter study reports that only one of the centers used it without performing a statistical analysis of what this measurement could indicate. 61…”

Langzeiterfahrung mit Collagenase Clostridium Histolyticum (CCH, Xiapex®) zur Behandlung der Dupuytrenschen Kontraktur: Lessons learned

“…Entgegen der Zulassung (0,58 mg CCH) verwenden wir off-label stets den gesamten Inhalt (0,90 mg CCH) der Trockenstechampulle. Zahlreiche Studien belegten die Unbedenklichkeit dieser Dosiserhöhung [15][16][17]. Verheyden und Mitarb.…”

The Use of Residual Collagenase for Single Digits With Multiple-Joint Dupuytren Contractures

“…7 In addition, single CCH injections containing a dose higher than recommended by the FDA for 2 contractures have also been analyzed, with short-term results comparable with conventional CCH doses for single cords. 8,9 The manufacturer-and FDA-recommended preparation of CCH results in unused CCH that is discarded. Some authors have advocated injecting this residual CCH into smaller secondary cords.…”