Advanced

Collagenase injections for Dupuytren's disease : Prospective cohort study assessing 2-year treatment effect durability

Lauritzson, Anna and Atroshi, Isam LU (2017) In BMJ Open 7(3).
Abstract

Objectives To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. Design Prospective cohort study. Setting Orthopaedic Department in Sweden. Participants Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24-48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24-35 months (mean 26) after... (More)

Objectives To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. Design Prospective cohort study. Setting Orthopaedic Department in Sweden. Participants Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24-48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24-35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection. Outcome measures Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years. Results Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41-54) and for PIP 25° (17-32). No treatment-related adverse events were observed at the 2-year follow-up evaluation. Conclusions Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Collagenase, Dupuytren
in
BMJ Open
volume
7
issue
3
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85015728089
  • pmid:28298365
ISSN
2044-6055
DOI
10.1136/bmjopen-2016-012943
language
English
LU publication?
yes
id
8c036a77-2bc4-4cac-b248-ac6ab97af160
date added to LUP
2017-04-23 15:05:01
date last changed
2017-09-15 09:07:30
@article{8c036a77-2bc4-4cac-b248-ac6ab97af160,
  abstract     = {<p>Objectives To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. Design Prospective cohort study. Setting Orthopaedic Department in Sweden. Participants Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24-48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24-35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection. Outcome measures Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years. Results Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41-54) and for PIP 25° (17-32). No treatment-related adverse events were observed at the 2-year follow-up evaluation. Conclusions Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints.</p>},
  articleno    = {012943},
  author       = {Lauritzson, Anna and Atroshi, Isam},
  issn         = {2044-6055},
  keyword      = {Collagenase,Dupuytren},
  language     = {eng},
  month        = {03},
  number       = {3},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Collagenase injections for Dupuytren's disease : Prospective cohort study assessing 2-year treatment effect durability},
  url          = {http://dx.doi.org/10.1136/bmjopen-2016-012943},
  volume       = {7},
  year         = {2017},
}