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2017 ; 7
(3
): e012943
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Collagenase injections for Dupuytren s disease: prospective cohort study
assessing 2-year treatment effect durability
#MMPMID28298365
Lauritzson A
; Atroshi I
BMJ Open
2017[Mar]; 7
(3
): e012943
PMID28298365
show ga
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.
|*Finger Joint
[MESH]
|*Metacarpophalangeal Joint
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Collagenases/administration & dosage/*therapeutic use
[MESH]
free
free
free
