Adverse effects associated with collagenase clostridium histolyticum in Dupuytren disease: A prospective study

Background: Collagenase clostridium histolyticum is now recognized as a viable treatment for Dupuytren disease. The high rate of adverse effects reported in patients continues to spark debate and raise questions about the true frequency of effects and their associated mechanisms of action. Hypothesis: To investigate whether outcomes of CCH treatment are related to the number of adverse effects experienced. To evaluate short-term clinical outcomes in a series of patients. Material and methods: Prospective single-center cohort study. The Primary End Point for effectiveness at 30 days was deficit of 0 degrees-5 degrees. Adverse effects were evaluated during CCH injection, removal of the dressing prior to finger extension, and finger extension. To investigate the relationship between adverse effects and treatment effectiveness, we analyzed the association between number of effects and clinical outcome at 30 days. Results: A total of 208 injections were evaluated. The mean baseline contracture was 32.11 degrees. Ninety-four patients (45.2%) had a mild contracture. Treatment was effective at 30 days in 194 of the injections (93.3%). The rate of effectiveness per joint was 93.5% for metacarpophalangeal joints (n=129) and 92.9% for proximal-interphalangeal joints (n=65). In total, 734 adverse effects were reported (mean, 3.53). No statistically significant associations were identified between disease severity and secondary effects. Variance analysis showed statistically significant differences in patients with severe contractures (mean, 3.91; 95% CI 3.57-4.25), and in patients with proximal-interphalangeal contractures (mean, 4.17; 95% CI 3.76-4.59). Conclusions: We found no relationship between number of adverse effects and treatment effectiveness at one month following CCH injection. Level of proof: IV, cohort prospective study. (C) 2018 Elsevier Masson SAS. All rights reserved.