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Previous Volume 361:968-979 September 3, 2009 Number 10 Next

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ABSTRACT

Background Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease.

Methods We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial. The primary metacarpophalangeal or proximal interphalangeal joints of these patients were randomly assigned to receive up to three injections of collagenase clostridium histolyticum (at a dose of 0.58 mg per injection) or placebo in the contracted collagen cord at 30-day intervals. One day after injection, the joints were manipulated. The primary end point was a reduction in contracture to 0 to 5 degrees of full extension 30 days after the last injection. Twenty-six secondary end points were evaluated, and data on adverse events were collected.

Results Collagenase treatment significantly improved outcomes. More cords that were injected with collagenase than cords injected with placebo met the primary end point (64.0% vs. 6.8%, P<0.001), as well as all secondary end points (P0.002). Overall, the range of motion in the joints was significantly improved after injection with collagenase as compared with placebo (from 43.9 to 80.7 degrees vs. from 45.3 to 49.5 degrees, P<0.001). The most commonly reported adverse events were localized swelling, pain, bruising, pruritus, and transient regional lymph-node enlargement and tenderness. Three treatment-related serious adverse events were reported: two tendon ruptures and one case of complex regional pain syndrome. No significant changes in flexion or grip strength, no systemic allergic reactions, and no nerve injuries were observed.

Conclusions Collagenase clostridium histolyticum significantly reduced contractures and improved the range of motion in joints affected by advanced Dupuytren's disease. (ClinicalTrials.gov number, NCT00528606 [ClinicalTrials.gov] .)

Source Information

From the State University of New York (SUNY) at Stony Brook, Stony Brook (L.C.H., M.A.B.); Stanford Hospitals and Clinics, Palo Alto, CA (V.R.H.); the Hospital for Special Surgery, New York (R.N.H.); the Indiana Hand Center, Indianapolis (F.T.D.K.); Los Angeles (R.A.M.); and Auxilium Pharmaceuticals, Malvern, PA (T.M.S., J.R.).

Address reprint requests to Dr. Hurst at the Department of Orthopaedics, SUNY at Stony Brook, Health Science Center, Level 18, Rm. 020, Stony Brook, NY 11794-8181, or at lhurst{at}notes.cc.sunysb.edu.

Full Text of this Article

Related Letters:

Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture
Zhang P., Qin L., Holzer L. A., Holzer G., Hurst L. C., Badalamente M., Smith T.
Extract | Full Text | PDF  
N Engl J Med 2009; 361:2578-2580, Dec 24, 2009. Correspondence

This article has been cited by other articles:

• Zhang, P., Qin, L., Holzer, L. A., Holzer, G., Hurst, L. C., Badalamente, M., Smith, T. (2009). Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture. NEJM 361: 2578-2580 [Full Text]  
• (2009). Nonsurgical Approach to Dupuytren Contractures. JWatch General 2009: 1-1 [Full Text]  
• (2009). All you need to read in the other general journals. BMJ 339: b3608-b3608 [Full Text]