title: Efficacy and safety of concurrent collagenase clostridium histolyticum injections for multiple Dupuytren contractures.
abstract: OBJECTIVE
  To assess the safety and efficacy of 2 concurrent injections of collagenase clostridium histolyticum (CCH) in the same hand to treat multiple Dupuytren flexion contractures.
  
  
  METHODS
  In a multicenter, open-label phase IIIb study, 60 patients received two 0.58-mg CCH doses injected into cords affecting 2 joints in the same hand during 1 visit, followed by finger extension approximately 24 hours later. Efficacy at postinjection day 30 (change in flexion contracture and active range of motion, patient satisfaction, physician-rated improvement, and rates of clinical success [flexion contracture 5° or less]) and adverse events were summarized.
  
  
  RESULTS
  The concurrent injections were most commonly administered in cords affecting metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints on the same finger (47%) or 2 MCP joints on different fingers of the same hand (37%). Mean total (sum of the 2 treated joints) flexion contracture decreased 76%, from 87° to 24° (MCP joints: 86%; PIP joints: 66%). Mean total range of motion increased from 100° to 161°. Clinical success was 76% for MCP joints and 33% for PIP joints. Most patients were very satisfied (60%) or quite satisfied (28%) with treatment. Most investigators rated treated joints as very much improved (55%) or much improved (37%). The most common treatment-related adverse events (> 75% of patients) were contusion, pain in extremity, and edema peripheral (local edema). Most adverse events were mild to moderate in severity. Serious complications included 1 pulley rupture related to study medication and 1 flexor tendon rupture (following conclusion of the study). There were no systemic complications.
  
  
  CONCLUSIONS
  Results suggest that 2 affected joints can be effectively and safely treated with concurrent CCH injections. There was an increased incidence of some adverse events with concurrent treatment (pruritus, lymphadenopathy, blood blister, and skin laceration) compared with treatment of a single joint. High degrees of patient satisfaction and physician-rated improvement were reported.
  
  
  METHODS
  Therapeutic IV.
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.. Electronic address: sgcoleman@optusnet.com.au.
authors: Stephen
authors: S
authors: Coleman
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: David
authors: D
authors: Gilpin
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: F Thomas D
authors: FT
authors: Kaplan
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: Anthony
authors: A
authors: Houston
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: Gregory J
authors: GJ
authors: Kaufman
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: Brian M
authors: BM
authors: Cohen
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: Nigel
authors: N
authors: Jones
authors: Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia; the Indiana Hand to Shoulder Center, Indianapolis, IN; the Caboolture Clinical Research Centre, Caboolture, Queensland, Australia; Auxilium Pharmaceuticals, Inc., Chesterbrook, PA; and Auxilium Pharmaceuticals, Inc., Windsor, United Kingdom.
authors: James P
authors: JP
authors: Tursi
mesh_terms: D000368:Aged; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005384:Finger Joint / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008662:Metacarpophalangeal Joint / Q000187:drug effects / Q000503:physiopathology; D003012:Microbial Collagenase / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D019233:Retreatment
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase clostridium histolyticum (CCH); Dupuytren contracture; Dupuytren disease; patient satisfaction; treatment outcome