From the Research
Pharmacological treatment for Dupuytren's contracture should primarily involve collagenase Clostridium histolyticum (CCH, brand name Xiaflex) due to its effectiveness in improving contracture and quality of life, as demonstrated in the most recent and highest quality study 1.
Key Points
- The standard regimen for CCH consists of injecting 0.58 mg directly into the palpable cord, followed by a finger extension procedure 24-72 hours later to rupture the cord.
- Up to three injections per cord may be administered at 4-week intervals, with the goal of reducing contracture and improving hand function.
- Before considering CCH, steroid injections (such as triamcinolone 40 mg/mL) into the nodules may help reduce pain and inflammation in early disease, though they don't prevent progression.
- Topical treatments like verapamil 15% gel or nitroglycerin 0.2% ointment applied twice daily for 3-6 months have shown modest benefits in some patients by potentially inhibiting collagen production and promoting collagen breakdown.
Considerations
- Recurrence rates remain significant with all treatments, and severe contractures (>30 degrees) typically require surgical intervention rather than pharmacological management alone.
- The most recent study 1 compared CCH to limited fasciectomy and found that CCH was not noninferior to limited fasciectomy with respect to the score on the Patient Evaluation Measure-Hand Health Profile (PEM) at 1 year after treatment.
- However, CCH is still a viable treatment option due to its minimally invasive nature and potential for improved quality of life, as demonstrated in other studies 2, 3, 4.
Recommendations
- CCH should be considered as a first-line treatment for Dupuytren's contracture, especially for patients with moderate contracture and those who prefer a minimally invasive approach.
- Patients should be well-informed about the potential benefits and risks of CCH, including local reactions and transient pain, as well as the possibility of recurrence.
- Further research is needed to fully understand the long-term efficacy and safety of CCH, as well as its comparison to other treatment options, such as limited fasciectomy and percutaneous needle fasciotomy.