School of Medicine and Health Sciences Poster Presentations

Title

A systematic review of complications and recurrence following treatment of Dupuytren's contracture with injectable collagenase clostridium histolyticum

Document Type

Poster

Abstract Category

Health Sciences

Keywords

Dupuytren's Contracture, Collagenase Clostridium Histolyticum, Injectable Collagenase, Hand Surgery

Publication Date

Spring 5-1-2019

Abstract

To investigate complications and recurrence of Dupuytren's contracture following injectable collagenase clostridium histolyticum (CCH) treatment through a systematic literature review and meta-analysis. A systematic literature review identified 14 studies that met inclusion criteria, 7 of which investigated complications and 7 of which investigated recurrence following CCH treatment. Studies included were identified from an existing systematic review. Studies excluded did not report complications or recurrences, had recurrence follow up periods of <12 months, or were retracted from publication. Dupuytren's contracture was defined as a fixed-flexion contracture of the metacarpophalangeal joint (MCPJ) or proximal interphalangeal joint (PIPJ) of ≥20 in one or more non-thumb fingers. Clinical success was defined as a reduction in contracture ≤5 immediately following CCH treatment. Complications were reviewed in 1620 patients and 2591 joints (MCPJ=1201, PIPJ=1390) with a mean follow up of 6.9 months (SD=5.9). Initial MCPJ contractures were reduced from 47.4 (SD=4.4) to 7.5 (SD=0.5) within one month of CCH. 66.2% of MCPJs reached clinical success. Initial PIPJ contractures were reduced from 49.2 (SD=6.9) to 21.6 (SD=2.5) within one month of CCH. 28.4% of PIPJs reached clinical success. 55.2% of patients reported at least one treatment related adverse event: major events included tendon and pulley rupture (n=9; 0.56%), tendonitis (n=1, 0.06%), and anaphylaxis (n=1, 0.06%) while minor events affecting over 25% of patients included peripheral edema (90.3%), contusion (64.6%), extremity pain (30.6%), injection site pain (26.4%), and injection site hemorrhage (25.2%). Recurrences were reviewed 840 patients and 877 joints (MCPJ=609, PIPJ=268) with follow ups ranging 12 to 96 months. Initial MCPJ contractures were reduced from 48.3 (SD=7.0) to 22.8 (SD=34.8) within one month of CCH. 97.9% of MCPJs reached clinical success. Recurrences occurred in 197 (32.3%) of MCPJs. Initial PIPJ contractures were reduced from 43.9 (SD=8.7) to 15.7 (SD=6.9) within one month of CCH. 90.3% of PIPJs reached clinical success. Recurrences occurred in 126 (47.0%) of PIPJs. Interventions were performed in 15% of patients with recurrences. Trends in CCH outcomes, complications, and recurrences can be identified by systematic review. Meta-analyses will be performed to further investigate CCH therapy complications and recurrences.

Open Access

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Presented at Research Days 2019.

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A systematic review of complications and recurrence following treatment of Dupuytren's contracture with injectable collagenase clostridium histolyticum

To investigate complications and recurrence of Dupuytren's contracture following injectable collagenase clostridium histolyticum (CCH) treatment through a systematic literature review and meta-analysis. A systematic literature review identified 14 studies that met inclusion criteria, 7 of which investigated complications and 7 of which investigated recurrence following CCH treatment. Studies included were identified from an existing systematic review. Studies excluded did not report complications or recurrences, had recurrence follow up periods of <12 >months, or were retracted from publication. Dupuytren's contracture was defined as a fixed-flexion contracture of the metacarpophalangeal joint (MCPJ) or proximal interphalangeal joint (PIPJ) of ≥20 in one or more non-thumb fingers. Clinical success was defined as a reduction in contracture ≤5 immediately following CCH treatment. Complications were reviewed in 1620 patients and 2591 joints (MCPJ=1201, PIPJ=1390) with a mean follow up of 6.9 months (SD=5.9). Initial MCPJ contractures were reduced from 47.4 (SD=4.4) to 7.5 (SD=0.5) within one month of CCH. 66.2% of MCPJs reached clinical success. Initial PIPJ contractures were reduced from 49.2 (SD=6.9) to 21.6 (SD=2.5) within one month of CCH. 28.4% of PIPJs reached clinical success. 55.2% of patients reported at least one treatment related adverse event: major events included tendon and pulley rupture (n=9; 0.56%), tendonitis (n=1, 0.06%), and anaphylaxis (n=1, 0.06%) while minor events affecting over 25% of patients included peripheral edema (90.3%), contusion (64.6%), extremity pain (30.6%), injection site pain (26.4%), and injection site hemorrhage (25.2%). Recurrences were reviewed 840 patients and 877 joints (MCPJ=609, PIPJ=268) with follow ups ranging 12 to 96 months. Initial MCPJ contractures were reduced from 48.3 (SD=7.0) to 22.8 (SD=34.8) within one month of CCH. 97.9% of MCPJs reached clinical success. Recurrences occurred in 197 (32.3%) of MCPJs. Initial PIPJ contractures were reduced from 43.9 (SD=8.7) to 15.7 (SD=6.9) within one month of CCH. 90.3% of PIPJs reached clinical success. Recurrences occurred in 126 (47.0%) of PIPJs. Interventions were performed in 15% of patients with recurrences. Trends in CCH outcomes, complications, and recurrences can be identified by systematic review. Meta-analyses will be performed to further investigate CCH therapy complications and recurrences.