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Yamamoto M, Yasunaga H, Kakinoki R, Tsubokawa N, Morita A, Tanaka K, Sakai A, Kurahashi T, Hirata H. The CeCORD-J study on collagenase injection versus aponeurectomy for Dupuytren's contracture compared by hand function and cost effectiveness. Sci Rep 2022; 12:9094. [PMID: 35641603 PMCID: PMC9156707 DOI: 10.1038/s41598-022-12966-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
This study compared hand function and the cost-effectiveness of treatment between collagenase Clostridium histolyticum (CCH) injection and limited fasciectomy for patients with Dupuytren’s contracture (DC). The CeCORD-J study is a prospective, multicenter, non-randomized controlled, observational study of two parallel groups. Participants were DC patients with multiple affected fingers, including flexion contracture of the proximal interphalangeal (PIP) joint. The primary outcome was the Hand10 score, as a patient-reported outcome measure (PROM). We set secondary outcomes of EQ-5D-5L (QOL) score, degree of extension deficit, and direct cost. Propensity score adjustment was used to balance differences in patient characteristics between groups. Participants comprised 52 patients in the Collagenase group and 26 patients in the Surgery group. There were no significant differences in the Hand10 and QOL scores between the two groups at 26 weeks. Mean direct cost was 248,000 yen higher in the Surgery group than in the Collagenase group. Extension deficit angle of the PIP joint was significantly larger in the Collagenase group at 26 weeks. Although the Collagenase group showed dominance in cost-effectiveness, there was no significant difference between the two groups in hand function at 26 weeks.
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Affiliation(s)
- Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Tokyo University, Tokyo, Japan
| | - Ryosuke Kakinoki
- Department of Orthopaedic Surgery, Kindai University, Osaka Sayama, Japan
| | - Naoto Tsubokawa
- Department of Hand Surgery, Niigata Hand Surgery Foundation, Seiro, Japan
| | - Akimasa Morita
- Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University, Nagasaki, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, the University of Occupational and Environmental Health, Kitakyusyu, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Warwick D, NM Werker P, Pess G, Hirata H, Hunter-Smith DJ. Dupuytren's disease: using needles more across the world. J Hand Surg Eur Vol 2022; 47:80-88. [PMID: 34496664 PMCID: PMC8721555 DOI: 10.1177/17531934211043307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
In this article we take an international perspective on the use of needles, either percutaneous needle fasciotomy (PNF) or Clostridial Collagenase Histiolyticum (CCH), in treating Dupuytren's Disease (DD). Worldwide, PNF is now used more frequently. The CCH has been withdrawn from non-USA markets, which lessens its use. Different patients have different preferences, while different surgeons have different skills and opinions. The surgeon should fully consider the patient's preference and should also, in view of the scarcity of surgical resource and the potential hazard of surgery, reconsider and expand the use of a needle rather than an operation. In the future, a cheaper, yet equally safe and effective alternative to CCH, will provide a useful clinical tool for those cords, which, in the surgeon's personal Venn diagram, are too challenging for PNF, but the patient does not want to have surgery.
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Affiliation(s)
| | - Paul NM Werker
- Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Gary Pess
- Central Jersey Hand Surgery, Eatontown, NJ, USA
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School & Faculty of Medicine Nagoya University, Nagoya, Japan
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Clinical School at Monash University, Melbourne, Australia
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Iwakawa H, Uchiyama S, Fujinaga Y, Hayashi M, Komatsu M, Kato H, Takahashi J. Magnetic resonance imaging of diffusion characteristics following collagenase clostridium histolyticum injection in Dupuytren's contracture. J Orthop Surg (Hong Kong) 2021; 29:23094990211047281. [PMID: 34654338 DOI: 10.1177/23094990211047281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PurposeWe aimed to evaluate the extent of collagenase clostridium histolyticum (CCH) diffusion in Dupuytren's contracture (DC) for tissues outside of the contracture cord using Magnetic Resonance Imaging (MRI) immediately after CCH injection. Methods: 10 male patients aged 57-79 with DC of the metacarpophalangeal (MCP) joints were examined. Extension deficits were 10-60°(mean, 34.3) and 0-60°(mean, 26.6) in the MCP and proximal interphalangeal (PIP) joints, respectively. CCH injection was performed according to the standard method. MRI was performed within 15 min of CCH injection. Results: In all 10 cases, the extended area of high-intensity signal change outside of the cord was observed on short-T1 inversion recovery images (STIRs). Continuity from the insertion site was observed in the area of signal change involving the flexor tendon and neurovascular bundle. The signal change area spanned distally and proximally beyond the injection level. The signal change area expanded along the tendon sheath but no signal changes were observed inside the flexor tendon, suggesting the tendon sheath serves as a protective barrier from the CCH solution. After 1 week of injection, the mean decrease in contracture was 32.5°(94.7%) for the MCP joint and 19.8°(74.4%) for the PIP joint. In nine out of 10 cases, the extension deficit was within five degrees of full extension in the affected finger. There was no neurovascular injury or tendon rupture at 3 months of observation. Conclusions: MRI indicated the possible leakage of the drug outside of the cord during the early phase after administration, suggesting that CCH could persistently affect healthy tissues until CCH inactivates its enzyme process.
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Affiliation(s)
- Hiroko Iwakawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Hayashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masatoshi Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Kuboi T, Tajika T, Endo F, Goto W, Nakajima I, Hasegawa S, Nakajima D, Hasokawa T, Chikuda H. Collagenase Clostridium histolyticum Injection Therapy Improves Health-related Quality of Life in Patients with Dupuytren's Disease. Prog Rehabil Med 2021; 6:20210023. [PMID: 34056142 PMCID: PMC8149854 DOI: 10.2490/prm.20210023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study was conducted to investigate the changes in clinical and psychosocial outcomes in patients with Dupuytren’s disease after initial treatment with collagenase Clostridium histolyticum (CCH) injection. Methods: This study involved 14 patients with Dupuytren’s disease who underwent treatment with CCH injection. The range of motion of each phalangeal joint was measured before treatment and at 6 months posttreatment. The following assessments were also carried out pre- and posttreatment: the Geriatric Depression Scale Short – Japanese version (GDS-J) to evaluate depressive status, Hand 10 to assess hand health status, and EuroQol-5-dimension-3-level Japanese version to evaluate health-related quality of life Results: Significant improvements were found in metacarpophalangeal joint extension and proximal interphalangeal joint extension. Significant differences were also found between values before the initiation of CCH injection and those at 6 months posttreatment for the EuroQol index score and the EuroQol Visual Analog Scale (VAS). Significant positive correlations were found between the pre- to posttreatment change in GDS-J scores and for the change in Hand 10 scores. Moreover, a significant negative correlation was found between the change in GDS-J scores and change in EuroQol index scores/EuroQol VAS scores before and at 6 months after CCH injection. Conclusions: For patients with Dupuytren’s disease, CCH therapy directly improved the health-related quality of life. The degree of improvement of depressive status was associated with the degree of improvement of hand health status and health-related quality of life.
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Affiliation(s)
- Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Wataru Goto
- Department of Orthopaedic Surgery, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Ichiro Nakajima
- Department of Orthopaedic Surgery, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Satoshi Hasegawa
- Department of Orthopaedic Surgery, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Daisuke Nakajima
- Department of Orthopaedic Surgery, Fujioka General Hospital, Fujioka, Japan
| | - Takafumi Hasokawa
- Department of Orthopaedic Surgery, Tone Central Hospital, Numata, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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Karpinski M, Moltaji S, Baxter C, Murphy J, Petropoulos JA, Thoma A. A systematic review identifying outcomes and outcome measures in Dupuytren's disease research. J Hand Surg Eur Vol 2020; 45:513-520. [PMID: 32009497 DOI: 10.1177/1753193420903624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This systematic review summarizes the outcome reporting standards in Dupuytren's disease treatment research. A search of Ovid Medline, Ovid Embase, and CINAHL was conducted. Randomized controlled trials, cohort studies, and case series published between 1997 and 2017, investigating treatment of Dupuytren's disease with fasciectomy, fasciotomy, or collagenase, were eligible for inclusion. Range of motion was the most commonly reported outcome, appearing in 77% of included studies. Outcomes, such as range of motion, recurrence, and clinical success, were frequently defined, however many different definitions were used. We identified 37 unique measurement methods for range of motion, 28 for recurrence, and 25 for clinical success. Most outcomes were assessed at multiple time points, and only a few studies reported results according to established clinical significance thresholds. Development of a core outcome set will help standardize outcome reporting, and ensure future research in this field is relevant, interpretable, and amenable to systematic review and/or meta-analysis.
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Affiliation(s)
- Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Charmaine Baxter
- Division of Plastic Surgery, McMaster University, Hamilton, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Canada
| | | | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Canada.,Department of Surgery, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Noto K, Yamamoto M, Iwatsuki K, Kurimoto S, Tatebe M, Hirata H. Acute Pain Intensity After Collagenase Clostridium histolyticum Injection in Patients With Dupuytren Contracture. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:16-20. [PMID: 35415475 PMCID: PMC8991417 DOI: 10.1016/j.jhsg.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/11/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To investigate multidimensional pain intensity and quality after collagenase Clostridium histolyticum (CCH) injection in patients with Dupuytren contracture using a pain visual analog scale (VAS) and the revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2). Methods This prospective observational study was carried out from 2015 to 2017. As a primary end point, patients completed the pain VAS (range, 0 [no pain] to 100) and SF-MPQ-2 before and after CCH injection; 3, 9, and 24 hours after CCH injection; after the extension procedure; and 3 and 7 days after CCH injection. In addition, they reported the dose and duration of supplementary analgesic use during this period. Results A total of 41 patients were enrolled in this study (51 joints). Mean pain VAS score (mean ± SD, 34 ± 21) was maximal 9 hours after CCH injection and decreased within the following 7 days. The total score of the SF-MPQ-2 significantly increased after CCH treatment and decreased in the 7 days after the injection. Among the SF-MPQ-2 subscales, the highest and lowest scores after CCH injection were recorded for continuous pain and affected descriptors, respectively. Nonsteroidal anti-inflammatory drugs were most frequently self-administered during 7 days after the extension procedure compared with any other study period. Conclusions The pain VAS and SF-MPQ-2 revealed acute pain after CCH injection. However, all examined pain aspects dramatically improved within 7 days after injection. Pain after CCH injection is characterized by low scores in the Affective Descriptors subscale of the SF-MPQ-2. Type of study/level of evidence Prognostic Ⅳ.
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Sanjuan-Cervero R. Current role of the collagenase Clostridium histolyticum in Dupuytren's disease treatment. Ir J Med Sci 2019; 189:529-534. [PMID: 31713028 DOI: 10.1007/s11845-019-02127-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Collagenase Clostridium histolyticum (CCH) is a recent treatment for Dupuytren disease, which is a fibroproliferative disorder that leads to progressive, persistent digital flexion contracture that interferes with basic daily activities. While CCH has changed the treatment of this hand disorder, numerous concerns have to be analyzed. AIMS Our purpose is to assess the current status of this medical treatment. METHODS Literary review based on a manual search on PubMed, Web of Science, and Google Academic. RESULTS Pharmacoeconomic analyses support the use of CCH, but long-term studies showing that it should be favored over conventional surgery or other treatments are lacking. Treatment decisions, therefore, must be guided by current data, which include a 5-year recurrence rate of 47%. Complications following CCH treatment are also a controversial topic, as rates of over 90% have been reported, although most of the complications are mild and self-limiting. A definition and classification of CCH-related complications is sorely needed. If we exclude adverse effects that could be considered inherent to the mechanisms of action of CCH, then the complication rate would be similar to rates reported for other techniques. Although CCH is becoming an increasingly popular treatment for Dupuytren disease, the potential applications of this modality, are much higher than currently believed, for more disorders characterized by excessive fibrosis. CONCLUSION Currently, the administration of this treatment is promising although long-term studies are necessary to see the real role that this drug can play in both Dupuytren's disease and other fibrotic disorders.
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Affiliation(s)
- Rafael Sanjuan-Cervero
- Orthopedic and Trauma Department, Hospital de Denia, Partida Beniadla s/n, 03700, Alicante, Denia, Spain.
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Kawano Y, Hagiwara T, Tanaka N, Nakamura T, Takeda H, Itabashi T, Furukawa M, Kikuchi K, Okuyama K. Vascular Complication after Collagenase Injection and Manipulation for Dupuytren's Contracture: A Case Report. JMA J 2019; 2:196-199. [PMID: 33615032 PMCID: PMC7889785 DOI: 10.31662/jmaj.2018-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
A case of a vascular complication after collagenase injection and manipulation for Dupuytren's contracture in a 57-year-old Japanese man is described. The patient presented with a 10-year history of worsening primary Dupuytren's contracture. The metacarpophalangeal joint of his left little finger had a flexion contracture of 40° and was treated by collagenase injection. When the patient returned to our hospital for manipulation 24 hours later, however, his left little finger was almost completely improved because he hit his finger on the car's gear lever. Then, 9 months after collagenase injection, in the first winter, he complained of a painful and pale left little finger occurring a few times a day, lasting for about 10 minutes. Now, two years after collagenase injection, the episodes of Raynaud's phenomenon remain. Although Raynaud's phenomenon after collagenase injection and manipulation for Dupuytren's contracture is considered rare, it is a complication to be noted.
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Affiliation(s)
- Yusuke Kawano
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Takeshi Hagiwara
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Nobuyuki Tanaka
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Takumi Nakamura
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Hiroki Takeda
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Tadashi Itabashi
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Mitsuru Furukawa
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Kentaro Kikuchi
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Kunimasa Okuyama
- Department of Orthopaedic Surgery, Shizuoka City Shimizu Hospital, Shizuoka, Japan
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Hatta T, Goto H, Sonofuchi K, Itoi E. Efficacy of collagenase Clostridium histolyticum injection for Dupuytren's contracture in East-Asian population. J Orthop Sci 2019; 24:431-433. [PMID: 30392715 DOI: 10.1016/j.jos.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/06/2018] [Accepted: 10/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment with injection of collagenase Clostridium histolyticum (CCH) has been recognized as an effective option for the Dupuytren's contracture (DC) in Europe and North America. However, there are no studies describing mid-term efficacy of CCH treatment in East-Asian population. The purpose of this study was to assess 2-year outcomes following CCH treatment in Japanese patients. METHODS Twenty hands (28 joints) from 18 DC patients underwent CCH injection with manipulation according to the product specifications with 2-year follow-up. Patients were assessed for extension deficit on treated metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints before treatment, at 4 weeks and 2 years after the treatment. RESULTS At 4 weeks after CCH treatment, contracture of treated joints significantly improved from the mean extension deficit of 45° before treatment to 3° for MCP joints, and from 41° to 14° for PIP joints (P < 0.001, <0.001, respectively). Improved contracture was maintained with 4° and 23° at 2 years after CCH treatment (P < 0.001, <0.05, respectively). Successful correction defined as ≤ 5° extension deficit was obtained in 14/16 MCP and 5/12 PIP joints at 4 weeks; of these, 11 MCP and 1 PIP joints maintained the corrected range of motion at 2-year follow-up. CONCLUSION CCH treatment could be a useful option to improve contracture in Japanese patients. During 2-year follow-up, this treatment could provide comparable effect durability to previous studies from Western countries. Moreover, our results support the evidence that better correction of the contracture can be obtained in the MCP joints than PIP joints after CCH treatment.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Japan.
| | - Hitoshi Goto
- Department of Orthopedic Surgery, Goto Clinic, Japan
| | | | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Japan
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Short-term efficacy and safety of collagenase injection for Dupuytren's contracture: Therapy protocol for successful outcomes in a clinical setting. J Orthop Sci 2019; 24:434-440. [PMID: 30392714 DOI: 10.1016/j.jos.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the short-term efficacy and safety of collagenase injection for Dupuytren's contracture and of our post-injection therapy protocol alternative the instruction of phase III studies at clinical setting. METHODS The retrospective study included 23 fingers of 21 hands of 18 patients for primary metacarpophalangeal (MP) joints and 11 fingers of 10 hands of 10 patients for primary proximal interphalangeal (PIP) joints with Dupuytren's contracture who were treated with 0.58 mg collagenase Clostridium histolyticum (CCH) injections at our hospital consecutively from September 2015 to October 2017. The mean age of the patients was 73.0 years (range, 57-88) for primary MP joints and 70.7 years (61-81) for primary PIP joints. Following standard CCH injection and manipulation on the next day, certified hand surgeons evaluated and treated each patient based on a defined 4-week therapy protocol that consisted of performing finger exercises during the day and wearing static extension splint at night for all cases, and of wearing Capener dynamic splint intervention to address severely contracted PIP joints. We measured the degree of contracture at baseline, immediately, 4 weeks, and 12 weeks after the last manipulation. RESULTS More improvement of contracture was seen in the MP joints than in the PIP joints. For the five fingers severely contracted and treated with Capener splint intervention, the mean passive PIP joint contracture was 62.0° at baseline, 21.0° immediately, further improved to 6.0° by 4 weeks, and maintained 8.0° by 12 weeks after the last manipulation. The adverse events were mild-to-moderate local reactions in the injected hand. CONCLUSIONS The clinical efficacy and safety of CCH were confirmed in a clinical setting similar to phase III studies. The improvement of 4-week-intervention was maintained at 12 weeks after the last manipulation. Severely contracted PIP joints could benefit from Capener splint intervention.
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Sakai A, Zenke Y, Menuki K, Yamanaka Y, Tajima T, Uchida S. Current Smoking Is Associated with Delayed Wound Healing But Not with Improvement of Contracture after the Open Palm Technique for Dupuytren's Disease. J Hand Surg Asian Pac Vol 2019; 24:65-71. [PMID: 30760148 DOI: 10.1142/s2424835519500127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some cases treated with open palm technique need relatively long wound healing time. This study aims to clarify whether the preoperative lifestyle-related diseases or factors are associated with surgical results after the open palm technique for Dupuytren's contracture. METHODS The study included 122 fingers of 84 hands of 84 consecutive male patients with Dupuytren's contracture who were treated with McCash's open palm technique at our hospital from 1980 to 2016. The average age of the patients was 68.0 years (range, 39-86). The follow-up period was at least 6 months (average, 36.3 months). Using multiple regression analysis, we investigated preoperative factors associated with surgical results. The factors examined were age, affected side, contracture of the little finger, number of contracted fingers, contracture of the proximal interphalangeal (PIP) joint, Meyerding classification, diabetes mellitus, hypertension, alcohol intake, and smoking. Surgical results were judged at 6 months after surgery and wound healing time was evaluated. RESULTS According to Tubiana's criteria, there were 59 excellent hands (70.2%), 18 good hands (21.4%), 5 fair hands (6.0%), and 2 poor hands (2.4%) at the final physical examination after surgery. The average of the percentage of improvement in contracture was 86.1%. The average number of days needed until complete open wound closure was 22.9 days. Multiple regression analysis revealed that the significant preoperative factors associated with the percentage of improvement in contracture were multiple contracted fingers and involvement of PIP joint contracture, and that the factor associated with delayed wound healing was current smoking. CONCLUSIONS Multiple contracted fingers and involvement of PIP joint contracture are associated with insufficient improvement of joint contracture. Current smoking is associated with delayed wound healing, but not with improvement of joint contracture, after the open palm technique for Dupuytren's disease in men.
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Affiliation(s)
- Akinori Sakai
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukichi Zenke
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kunitaka Menuki
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiaki Yamanaka
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takafumi Tajima
- * Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- † Department of Orthopaedic Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
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Sanjuan-Cerveró R, Carrera-Hueso FJ, Vazquez-Ferreiro P. Adverse effects associated with collagenase clostridium histolyticum in Dupuytren disease: A prospective study. Orthop Traumatol Surg Res 2018; 104:901-905. [PMID: 30253866 DOI: 10.1016/j.otsr.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/22/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Collagenase clostridium histolyticum is now recognized as a viable treatment for Dupuytren disease. The high rate of adverse effects reported in patients continues to spark debate and raise questions about the true frequency of effects and their associated mechanisms of action. HYPOTHESIS To investigate whether outcomes of CCH treatment are related to the number of adverse effects experienced. To evaluate short-term clinical outcomes in a series of patients. MATERIAL AND METHODS Prospective single-center cohort study. The Primary End Point for effectiveness at 30 days was deficit of 0°-5°. Adverse effects were evaluated during CCH injection, removal of the dressing prior to finger extension, and finger extension. To investigate the relationship between adverse effects and treatment effectiveness, we analyzed the association between number of effects and clinical outcome at 30 days. RESULTS A total of 208 injections were evaluated. The mean baseline contracture was 32.11°. Ninety-four patients (45.2%) had a mild contracture. Treatment was effective at 30 days in 194 of the injections (93.3%). The rate of effectiveness per joint was 93.5% for metacarpophalangeal joints (n=129) and 92.9% for proximal-interphalangeal joints (n=65). In total, 734 adverse effects were reported (mean, 3.53). No statistically significant associations were identified between disease severity and secondary effects. Variance analysis showed statistically significant differences in patients with severe contractures (mean, 3.91; 95% CI 3.57-4.25), and in patients with proximal-interphalangeal contractures (mean, 4.17; 95% CI 3.76-4.59). CONCLUSIONS We found no relationship between number of adverse effects and treatment effectiveness at one month following CCH injection. LEVEL OF PROOF IV, cohort prospective study.
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Affiliation(s)
- Rafael Sanjuan-Cerveró
- Orthopedics and Traumatology Surgery, Hospital de Denia, Partida Beniadlà, S/N, Denia, 03700 Alicante, Spain; University of Granada, Spain.
| | | | - Pedro Vazquez-Ferreiro
- University of Granada, Spain; Ophtalmologic Department, Hospital Virxen da Xunqueira, Cee, 15270 A Coruña, Spain
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Sanjuan-Cerveró R, Carrera-Hueso FJ, Vazquez-Ferreiro P, Gomez-Herrero D. Adverse Effects of Collagenase in the Treatment of Dupuytren Disease: A Systematic Review. BioDrugs 2017; 31:105-115. [PMID: 28181175 DOI: 10.1007/s40259-017-0211-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Collagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to those achieved with surgery, and most adverse effects are self-limiting and considered to be mild or moderate. OBJECTIVE Our objective was to conduct a systematic review of the adverse effects of CCH in DD since the release of the drug to evaluate the incidence, severity, classification, and definitions of these effects. METHODS We analyzed the literature in terms of modifications to the original treatment protocol and grouped adverse effects according to their pathophysiological origin. RESULTS We included 28 clinical studies and five case reports or case series analyzing 4456 patients with a mean age of 63.6 years. Mean follow-up was 7.07 months (range 3-24); the mean number of patients per study was 148 (range 5-1082). The studies did not classify the adverse effects they reported into groups. The most common effects were peripheral edema (54.4%), bruising (42.9%), and upper limb pain (28.3%). Significant biases were observed for use of terminology, demarcation of sites of involvement, severity criteria, and assessment methods. CONCLUSION A simpler and clearer consensus-based classification system would enable better evaluation and comparison of the adverse effects of CCH in the treatment of DD. Consideration of inflammatory phenomena as part of the drug's mechanism of action would significantly reduce overall rates of adverse effects.
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Affiliation(s)
- Rafael Sanjuan-Cerveró
- Orthopedics and Traumatology Surgery, Hospital de Denia, Partida Beniadlà, S/N, Denia, 03700, Alicante, Spain. .,University of Granada, Granada, Spain.
| | | | - Pedro Vazquez-Ferreiro
- University of Granada, Granada, Spain.,Ophthalmologic Department, Hospital Virxen da Xunqueira, Cee, A Coruña, Spain
| | - Diego Gomez-Herrero
- University of Granada, Granada, Spain.,Pharmacy Service, Hospital Nisa Rey Don Jaime, Castellón, Spain
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