Main Article Content
microbial collagenase, dupuytren contracture, collagenases, treatment outcome, patient reported outcome measures
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.
2. Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, Smith TM, Rodzvilla J. Injectable collagenase clostridium histolyticum for dupuytren’s contracture N Engl J Med 2009;361(10):968–79 https://doi.org/10.1056/NEJMoa0810866 PMid:19726771
3. Ball C, Pratt AL, Nanchahal J. Optimal functional outcome measures for assessing treatment for dupuytren’s disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord. 2013;14(1):131 https://doi.org/10.1186/1471-2474-14-131 PMid:23575442 PMCid:PMC3637830
4. Tubiana R. Planning of surgical treatment. The Hand 1975;7(3):223–27. https://doi.org/10.1016/0072-968X(75)90057-1
5. Shaw RB, Chong AK, Zhang A, Hentz VR, Chang J. Dupuytren’s disease: history, diagnosis, and treatment. Plast Reconstr Surg. 2007;120(3):44e–54e. https://doi.org/10.1097/01.prs.0000278455.63546.03 PMid:17700106
6. Eaton C. Evidence-based medicine: Dupuytren contracture. Plast Reconstr Surg. 2014;133(5):1241–251. https://doi.org/10.1097/PRS.0000000000000089 PMid:24776555
7. Lee Matthew VK, Hunter-Smith D. Needle fasciotomy for dupuytren’s disease: an Australian perspective. ANZ J Surg. 2009;79(11):776–78. https://doi.org/10.1111/j.1445-2197.2009.05101.x PMid:20078523
8. Eaton C. Percutaneous fasciotomy for dupuytren’s contracture. J Hand Surg Am. 2011;36(5):910–15. https://doi.org/10.1016/j.jhsa.2011.02.016 PMid:21527145
9. Beaudreuil J, Allard A, Zerkak D, Gerber RA, Cappelleri JC, Quintero N, Lasbleiz S, Bernabé B, Orcel P, Bardin T, URAM Study Group. Unité Rhumatologique des Affections de la Main (URAM) scale: development and validation of a tool to assess dupuytren’s disease-specific disability. Arthritis Care Res. 2011;63(10):1448–455. https://doi.org/10.1002/acr.20564 PMid:21786431
10. Mohan A, Vadher J, Ismail H, Warwick D. The Southampton dupuytren’s scoring scheme. J Plast Surg Hand Surg. 2014;48(1):28–33. https://doi.org/10.3109/2000656X.2013.794349 PMid:24428161
11. Chatman AB, Hyams SP, Neel JM, Binkley JM, Stratford PW, Schomberg A, Stabler M. The patient-specific functional scale: measurement properties in patients with knee dysfunction. Phys Ther. 1997;77(8):820–29. https://doi.org/10.1093/ptj/77.8.820 PMid:9256870
12. Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can. 1995;47(4):258–63. https://doi.org/10.3138/ptc.47.4.258
13. STATA Statistical Software. Release fifteen [web page]. StataCorp . Available from: https://www.stata.com.
14. Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N. Injectable collagenase clostridium histolyticum: a new nonsurgical treatment for dupuytren’s disease. Hand Surg Am. 2010;35(12): 2027–38. https://doi.org/10.1016/j.jhsa.2010.08.007 PMid:21134613