Dupuytren’s Contracture Recurrence and Treatment Following Collagenase Clostridium Histolyticum Injection: A Longitudinal Assessment in a Veteran Population

• Published in: Military medicine 2023-08, Vol.188 (9-10), p.e2975-e2981
• Main Authors: Zarb, Rakel M, Graf, Alexander R, Talhelm, Jacob E, Stehr, Ryan C, Sanger, James R, Matloub, Hani S, Daley, Roger A
• Format: Article
• Language: English
• Subjects: Collagen; Connective tissue diseases; Drug therapy; Longitudinal studies; Veterans
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usad075

ABSTRACT Introduction Dupuytren’s contracture is a connective tissue disease characterized by an abnormal proliferation of collagen in the palm and fingers, which leads to a decline in hand function because of progressive joint flexion. In addition to surgical and percutaneous interventions, collagenase clostridium histolyticum (CCH, trade name Xiaflex) is an intralesional enzymatic treatment for adults with palpable cords. The objectives of this study are to evaluate factors predictive of recurrence following treatment with CCH and to review the outcomes of repeat treatments with CCH for recurrent contracture. Materials and Methods An institutional review board–approved retrospective chart review was conducted for patients between 2010 and 2017 who received CCH injections for Dupuytren’s contracture at a Veterans Affairs hospital. Demographics, comorbidities, affected finger and joint, pre/posttreatment contracture, time to recurrence, and treatment of recurrence were recorded. Successful treatment was defined as contracture ≤5° following CCH, and improvement was defined as ≥20° reduction from baseline contracture. Study cohorts were followed after their secondary treatment, and time to recurrence was recorded and plotted using a Kaplan–Meier curve. A Cox proportional hazards model was used to compare treatment group risk factors for recurrence with a P-value less than .05 defined as statistical significance. Results Of 174 injections performed for the correction of flexion deformities in 109 patients, 70% (121) were successfully treated with CCH, and an additional 20% (35) had improvement. There was a recurrence of contractures in 43 joints (25%). Of these, 16 contractures were treated with repeat CCH, whereas another 16 underwent limited fasciectomy. In total, 75% (12 of 16) of the repeat CCH group and 75% of the fasciectomy group were successfully treated. Pre-injection contracture of ≥25° was found to be predictive of recurrence (P