Treating Dupuytren’s Contracture by Injection, not Surgery
Tue, September 15, 2009 at 02:00AM Dupuytren’s contracture is a painless thickening and contracture of tissue under the skin on the palm of the hand and fingers. It limits hand function, and may even disable the hand. The standard treatment is surgical removal or transection of the band of connective collagen tissue, followed by some months of rehabilitation exercises. Now there’s a report in the New England Journal of Medicine about an injection that can “dissolve” the abnormal tissue.
Over 300 patients with advanced Dupuytren’s contractures were enrolled into a randomized, double-blind, placebo-controlled, multi-center study. The study was sponsored by the manufacturer of the collagenase product used. The subjects were randomly assigned to have injections of either collagenase clostridium histolyticum or a placebo into the contraction tissue. A day later, the treated joint was manipulated in an attempt to rupture the cord; if unsuccessful, the process was repeated, twice more if necessary, at 30-day intervals.
Thirty days after the final injection, 64% of the collagenase-treated patients had complete, or almost complete, ability to fully extend their affected joints; this compared with 7% of the placebo-injected patients. Nearly all the collagenase-treated patients had side effect effects (e.g., pain, swelling, itching), but most of these disappeared within 10 days.
An FDA Advisory Committee of experts is going to consider whether to recommend the drug's approval in the next day or so. I think, based on the results of this study, I’d prefer to have one or two injections that hand surgery, if I had Dupuytren’s.
Reader Comments (1)
FDA have today (Sept 16) approved the collagenase product for this use. See: http://www.medscape.com/viewarticle/709083?sssdmh=dm1.530084&src=nldne&uac=14070SR
Bob Griffith