Nové možnosti v léčbě Dupuytrenovy kontraktury / New Advances in treatment of Dupuytren contracture

Where are we now? A review of current treatment for Dupuytren’s contracture.

        By prim. MUDr. Alena Schmoranzová, Ústav chirurgie ruky a plastické chirurgie, Vysoké nad Jizerou

Emerging treatment: new data on collagenase  and clinical experiences

        By Dr. Zsolt Szabo, Ph.D, Miskolc, Hungary

Summary:

Dupuytren’s disease (DD) is a fibroproliferative hand condition causing progressive digital flexion contracture. This deformity results in considerable disability that can limit patient activity and quality of life. Current treatment option includes different medical and surgical procedures which comes with several disadvantages. In the majority of cases the treatment of choice is a surgical one. After surgery complications may occur, convalescence may be prolonged and extensive hand therapy is needed. In addition, not all patients with Dupuytren’s disease are appropriate candidates for surgery.  

A purified bacterial enzyme, collagenase clostridium histolyticum (Xiapex), has recently been approved for treatment of Dupuytren’s contracture by direct injection into the pathologic collagen deposit. It is a minimally invasive, non-surgical approach. Collagenase is injected into the affected cord and the next day the cord is manipulated to attempt the cord rupture. The substance consists of two distinct collagenases that cleave collagen strands at different sites, which leads to partial cord digestion.

Two pivotal randomized, double blind, placebo controlled studies (CORD I and CORD II) demonstrated the safety and efficacy of this new treatment approach. Xiapex demonstrates a clinically significant benefit compared to placebo. In CORD I trial 64% of patient achieved the reduction in contracture of all joints treated to 5° or less (compared to placebo 6,8%, p<0.001). Further Xiapex showed significantly greater percent reduction in contracture - 79,3% (as compared to placebo 8,6%, p<0.001) as well as greater improvement in range of motion (36,7º vs. 4,0 º, p<0.001).

Xiapex clearly represent novel effective approach to treatment of joint contracture caused by DD. The number and variety of complications has clearly demonstrated the fact that knowledge and understanding of this new treatment are mandatory to achieve good results. The importance of a training before the use of this drug can significantly reduce the possible complications.

Xiapex seems a “simple” injection at first glance, but the analysis of existing data and the accumulated experience supports the importance and necessity of knowledge and training previous to administration.