title: Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren contracture: report of 40 cases.
abstract: BACKGROUND
  Dupuytren's disease (DD) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers. The standard procedure is surgical fasciectomy, followed by high recurrence rates. Collagenase Clostridium histolyticum (CCH) injection represents an innovative noninvasive approach to the treatment of DD. This prospective study was designed to examine the efficacy and safety of CCH injection performed in the outpatient, using local anesthesia.
  
  
  METHODS
  Forty patients [32 metacarpophalangeal (MP), 8 proximal interphalangeal (PIP)] with Dupuytren's contracture of at least 20° for MP joint and any degree for PIP joint were included. The mean age was 66. All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after. All adverse effects (AEs) were monitored. Patients were checked 7, 30, 90, and 180 days after the injection. Primary endpoint was a reduction in digit contracture within 0°-5° of normal extension. Secondary endpoints were the improvement of range of motion, the evaluation of AEs incidence, and cost-effectiveness of collagenase treatment.
  
  
  RESULTS
  About 67.5 % of patients obtained a clinical success. At 6 months, a further 7.5% attained the same result. The mean contracture of treated joints was 5.3º for MP and 6.8° for PIP joints. Twenty-three patients had one or more mild-to-moderate side effects.
  
  
  CONCLUSIONS
  The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren's contracture. Therapeutic success was achieved in a significant percentage of patients. The incidence of side effects was higher, but they were local reactions of short duration. The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery.
authors.affiliation: Department of Hand Surgery, University Hospital of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Alberton
authors.forename: M
authors.initials: M
authors.lastname: Corain
authors.forename: A
authors.initials: A
authors.lastname: Garofano
authors.forename: L
authors.initials: L
authors.lastname: Pangallo
authors.forename: A
authors.initials: A
authors.lastname: Valore
authors.forename: V
authors.initials: V
authors.lastname: Zanella
authors.forename: R
authors.initials: R
authors.lastname: Adani
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000628:therapy; D004798:Enzymes / Q000008:administration & dosage / Q000191:economics; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000191:economics; D008297:Male; D008349:Manipulation, Orthopedic; D003012:Microbial Collagenase / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome
chemical_list: D004798:Enzymes; D003012:Microbial Collagenase