What is the evidence for collagenase injection for Dupuytren’s contracture?
AMSTAR Rating
Summary
Patient Population:
- Adult patients (>18 years old) with primary or recurrent dupuytren’s contracture with measurable flexion contracture of hand.
-
64.3 years ± 2.06 years. There were 81.5% males included.
- 4 studies
Intervention:
- Collagenase injection.
Comparison:
- Placebo injection.
Outcome:
Contracture reduction within 0-5° of full extension within 30 days.
- Contracture reduction: risk difference 0.62 (95% CI 0.40 to 0.83, I2=84%, p<0.01, 4 studies)
Relative reduction in total passive extension deficit within 30 days (i.e., proportion of patients who successfully had reduction in contracture to 0° to 5° of normal 30 days after the last injection).
- Relative reduction in total passive extension deficit: weighted mean difference 56.9% (95% CI 42.85% to 70.95%, I2not available, 1 study).
Adverse Effects
- Previously review noted that CI had higher rates of AE (pain, discomfort, local edema, bruising being common) compared to limited and needle fasciectomy
Guideline Recommendations
| Source | Recommendation |
|---|---|
| NICE | Withdrawn the guidance because collagenase clostridium histolyticum (Xiapex) is no longer available in the UK. |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Contracture Reduction
Collagenase Injection v. Placebo
Adverse Effects
CI v. Limited and Needle fasciectomy
Relevant Clinical Info
Collagenase injection is not currently available in some countries and regions including recently being discontinued in Canada and Europe.
See previous EBM reviews on Radiotherapy and Fasciectomy for Dupytren’s.
Participant Information
of participants
were Male
the sample size was 445
Mean age of 64 years.
their were 4 studies used.
