Different collagenase delivery for Dupuytren disease in public hospitals

Jessca A Paynter,Vicky Tobin,James Cs Leong,Warren Matthew Rozen,David J Hunter-Smith

doi:10.34239/ajops.v3n2.163

Abstract

Background: The delivery protocol of collagenase Clostridium histolyticum (collagenase) injection for Dupuytren’s disease is variable, due to limited evidence for any one approach and widespread ‘off-label’ delivery occurring in Australia. As such, this preliminary study aimed to assess whether different collagenase delivery protocols for treating Dupuytren’s disease have an impact on effectiveness and safety. It was hypothesised that different collagenase delivery would affect outcomes. Methods: This preliminary, prospective study included a consecutive cohort of adult patients with Dupuytren’s disease being treated with collagenase within two Australian public hospitals to determine whether different collagenase delivery protocols impact on effectiveness and safety. The therapeutic effect was measured objectively using the total passive extension deficit (TPED), clinical success and clinical improvement. Three patient-reported outcome measures (PROMs) were used: Unité Rhumatologique des Affections de la Main (URAM), the Southampton Dupuytren’s Scoring Scheme and the Canadian Occupational Patient-Specific Functional Scale (PSFS). Results: The delivery of collagenase was variable at both clinics. The number of patients treated with collagenase at Institute I and Institute II was 49 and 18, respectively. Clinical success was achieved in 42 per cent of the Institute I and 35 per cent of the Institute II cohort. A statistically significant reduction in all three PROMs was observed for both cohorts. No significant differences between effectiveness or safety was found when comparing the two cohorts. Conclusion: The delivery of collagenase was variable at Institutes I and II, but these differences did not appear to impact the effectiveness or safety of collagenase delivery.

Highlights

Dupuytren’s disease is a common, benign fibrotic disease resulting in finger flexion contractures.[1]
This study explored the application of collagenase as a therapeutic for people with Dupuytren’s disease within two public hospital clinics using different delivery protocols
The validity of adverse effects is lessened by the impact of recall or reporting bias. This could be further heightened by the memory and hearing impairments of the ageing cohort. These preliminary data demonstrate that collagenase results in improved functional outcomes, both objectively and as perceived by the patient

Summary

Introduction

Dupuytren’s disease is a common, benign fibrotic disease resulting in finger flexion contractures.[1]. Surgical correction of Dupuytren’s disease via fasciotomy, fasciectomy and dermofasciectomy has been the mainstay of therapy over recent decades.[5,6] Minimally invasive techniques include percutaneous needle aponeurotomy and collagenase injections. The delivery protocol of collagenase Clostridium histolyticum (collagenase) injection for Dupuytren’s disease is variable, due to limited evidence for any one approach and widespread ‘off-label’ delivery occurring in Australia. As such, this preliminary study aimed to assess whether different collagenase delivery protocols for treating Dupuytren’s disease have an impact on effectiveness and safety. It was hypothesised that different collagenase delivery would affect outcomes

Methods

Results

Discussion

Conclusion