Treatment of Dupuytren Contracture Recurrence After Surgery With Collagenase Clostridium Histolyticum: A Retrospective Multicenter Series

TL;DR

Collagenase injections can effectively treat Dupuytren contracture recurrence after surgery, offering a nonsurgical option with good results and minimal complications.

Contribution

Demonstrates collagenase clostridium histolyticum's efficacy for treating post-surgical Dupuytren recurrence in a large multicenter study.

Findings

Mean contracture improvement of 38° at last evaluation across treated joints.

58% of joints achieved clinical success with reduction to 0°–5° contracture.

Most adverse events like skin tears resolved spontaneously within 21 days.

Abstract

Dupuytren contracture (DC) is a fibroproliferative disorder characterized by collagen deposition in the palmar fascia. Treatment options include collagenase clostridium histolyticum (CCH) injection and surgery; however, DC frequently recurs after primary therapy. We hypothesized that CCH treatment could be effective and well tolerated for the treatment of contracture recurrence for patients unwilling to undergo reoperation or at high risk for complications.

This Phase 4, multicenter, noninterventional, retrospective study analyzed medical records from 10 clinical centers in the US. Patients were treated with CCH for DC recurrence ≥6 months after previously successful surgical correction performed between January 1, 2010, and August 15, 2020. Primary end points were the measured joint contracture change from baseline, at first and last clinical evaluation within 12 months of CCH treatment of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. Secondary end points were “clinical success” (percentage of joints with reduction in contracture to 0° to 5°) and adverse events.

Of 113 patients screened, 101 were analyzed (mean age, 64.1 years; 75% men). Median time to DC recurrence was 36.0 months. A total of 144 treated joints were analyzed (MP, n = 64; PIP, n = 75; unspecified, n = 5). Overall mean (SD) baseline contracture was 52° (21°) (MP, 43° [19°]; PIP, 61° [20°]). Mean (SD) improvement of contracture from baseline at last evaluation was 38° (21°) for all joints (MP, 36° [17°]; PIP, 41° [24°]), with 58% of joints having clinical success (MP, 75%; PIP, 43%). All skin tears (20 events in 19% of patients) resolved spontaneously, with 50% resolving in ≤21 days; there was one flexor profundus rupture that did not require secondary reconstruction.

This retrospective analysis indicates that CCH treatment is an effective and well tolerated nonsurgical option for recurrent postsurgical contracture, with results comparable to patients without prior surgery.

Therapeutic III.

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