Treatment of Dupuytren’s contracture

Soreide, Endre; Murad, M. Hassan; Denbeigh, Janet M.; Lewallen, Eric A.; Dudakovic, Amel; Nordsletten, Lars; Wijnen, André J. van; Kakar, Sanjeev

doi:10.1302/0301-620x.100b9.bjj-2017-1194.r2

Cited by 50 publications

(41 citation statements)

References 55 publications

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“…Surgical approaches such as open fasciectomy and percutaneous needle aponeurotomy are currently the gold standard for the treatment of Dupuytren's disease [124]. However, the clinical data evaluated in the present review highlight that anti-inflammatory strategies such as steroid treatment and TNF-α signalling inhibition might successfully reduce myofibroblast persistence and activity, making it a promising approach to complement (or potentially replace) the need for surgical procedures.…”

Section: Discussionmentioning

confidence: 90%

Pharmacological Treatment of Fibrosis: a Systematic Review of Clinical Trials

Siani

2020

SN Compr. Clin. Med.

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The term “fibrosis” refers to a spectrum of connective tissue disorders characterized by the excessive accumulation of extracellular matrix leading to organ dysfunction and, ultimately, failure. Fibrosis affects millions of patients worldwide and often manifests itself as a late-stage pathological condition associated with poor prognostic outcome. Although the aetiology and clinical course vary widely depending on the affected organ, fibrotic degeneration of different tissues is underpinned by similar molecular and cellular mechanisms, most notably the persistence and dysregulated activity of myofibroblasts. A systematic search of clinical trials was conducted using PubMed and Cochrane to qualitatively evaluate the effectiveness of different therapeutic approaches to the pharmacological targeting of myofibroblasts in patients affected by fibrotic disorders. The systematic search and screening returned 54 eligible clinical trials, 38 of which reported an improvement of the patients’ symptoms following treatment. The majority of the eligible articles focused on fibrotic degeneration of the respiratory system, skin, liver, and kidneys. The evaluation of clinical data unearthed commonalities between strategies that successfully ameliorated symptoms in patients affected by the same fibrotic disorder. However, none of the treatments evaluated in this study could improve symptoms across a range of fibrotic pathologies. These results indicate that, although no “one size fits all” treatment for fibrosis has yet been identified, the systematic analysis of clinical data can be used to inform the development of therapeutical strategies tailored to suit the diverse aetiology of each fibrotic condition.

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Section: Discussionmentioning

confidence: 90%

Pharmacological Treatment of Fibrosis: a Systematic Review of Clinical Trials

Siani

2020

SN Compr. Clin. Med.

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“…Multiple reviews have shown the benefits of CCH injection but limited follow-up periods and high recurrence rates should be noted 2223). One study with 25 patients with a longer-term follow-up (32 months) showed contracture improvement from 43.5° to 3.6° in MCP joints and from 30.0° to 17.5° in PIP joints 24).…”

Section: Discussionmentioning

confidence: 99%

Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up

2019

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Background Dupuytren disease is characterized by the development of palmar fibrous tissue that can lead to fixed flexion contracture (FFC) and contribute to functional loss of the involved digits. Our goal was to investigate rates of contracture resolution and recurrence in patients who underwent enzymatic fasciotomy for Dupuytren contracture consisting of collagenase clostridium histolyticum (CCH) injection followed by passive manipulation combined with splinting and home-based therapy. Methods We prospectively enrolled 34 patients (44 metacarpophalangeal [MCP] and 33 proximal interphalangeal [PIP] joints) treated by one orthopaedic hand surgeon between November 2010 and November 2014. On day 1, CCH was injected into a palpable fibrous cord of the involved fingers. The next day, the finger was passively extended to its maximal corrective position. FFC was measured for each joint before injection and immediately after manipulation. Patients were instructed to wear an extension splint at night and perform stretching exercises at home and were re-evaluated at 6 weeks, 4 months, 1 year, and 2 years. Resolution was defined as improvement of contracture to ≤ 5° of neutral. Recurrence was defined as an increase in FCC of ≥ 20° after treatment. Results Immediate contracture resolution occurred in 42 of 44 MCP joints ( p < 0.001), improving from 50° to 1.5°, and in 14 of 33 PIP joints ( p = 0.182), improving from 44° to 16°. Four joints had recurrence within 6 weeks. Of the 48 joints with minimum 4-month follow-up (mean, 26 months), 12 had recurrence at 2-year follow-up (MCP, 6; PIP, 6). At 2-year follow-up, MCP and PIP contractures measured 17° and 35.5°, respectively. Older age and multiple digit involvement were associated with higher recurrence rates. Conclusions CCH offers a safe, nonoperative option to correct FCC in Dupuytren disease with greater success for MCP joints compared to PIP joints. There is a tendency of reoccurrence within 2 years of treatment. Further investigation is needed to determine optimal timing of repeat CCH injection to improve upon or extend the period of contracture resolution.

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“…6 However, less invasive alternatives, such as enzymatic release with collagenase clostridium histolyticum (CCH) injection and manual division of cords using percutaneous needle aponeurotomy (PNA), have both demonstrated efficacy. 7 CCH and PNA are associated with faster recovery time and consume fewer resources than LF. [8][9][10] However, the likelihood that the contracture will recur following treatment may be greater for PNA and CCH.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of Recurrent Dupuytren Contracture Treatment

et al. 2020

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IMPORTANCE Owing to its tendency to recur, Dupuytren contracture often requires multiple treatments, which places additional economic burden on health care. The likelihood of contracture recurrence varies not only with treatment but also with disease characteristics, such as contracture severity and location, but prior cost-effectiveness analyses of Dupuytren contracture treatments have not considered these patient-specific disease characteristics. OBJECTIVE To identify the most cost-effective treatment regimen for patients with recurrent Dupuytren contracture. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted with statetransition microsimulation modeling using data from published studies and Medicare. A simulated cohort of 10 000 individuals with Dupuytren contracture was created. Patients could transition yearly between the following health states: symptom-free, symptomatic, and death. Available treatments were collagenase clostridium histolyticum injection, percutaneous needle aponeurotomy (PNA), and limited fasciectomy (LF); individuals randomly chose any treatment when symptomatic. Patients were limited to 3 rounds of treatment for a contracture affecting 1 joint, totaling 27 unique combinations. If the contracture recurred after 3 treatments, patients lived with the disease for the remainder of life.

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Treatment of Dupuytren’s contracture

Abstract: Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. Cite this article: Bone Joint J 2018;100-B:1138-45.

Cited by 50 publications

References 55 publications

Pharmacological Treatment of Fibrosis: a Systematic Review of Clinical Trials

Pharmacological Treatment of Fibrosis: a Systematic Review of Clinical Trials

Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up

Cost-effectiveness of Recurrent Dupuytren Contracture Treatment

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