The use of Collagenase Clostridium Histolyticum in the management of Dupuytren’s contracture-outcomes of a pilot study in a District General Hospital setting

INTRODUCTION: Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren’s contracture (DC). PATIENTS AND METHODS: Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 52(0) (range, 0 – 75(0)) and 35(0) (range, 0 – 84(0)) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 – 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). RESULTS: MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 – 10), which decreased to 8.6 (range, 6 – 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CONCLUSION: CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.