Clinical efficacy and cost-effectiveness of Clostridium histolyticum collagenase injections in a subpopulation of Dupuytren's contracture patients

A literature review and economic analysis was undertaken to establish evidence-based criteria. A pilot study using the criteria was designed, and 56 patients were included. Efficacy assessments were undertaken by measuring contracture angle of the effected metacarpophalangeal (MCP) joint using goniometry and the Unité Rhumatologique des Affections de la Main (URAM) scale with follow-ups at 1, 3, 6 and 12 months.

Significant improvements were seen in contracture angles as well as URAM scores when mean baseline and post-intervention outcomes were compared at 1, 3 and 6 months in the patient cohorts. The mean contracture angle at 1 month follow-up (n = 56) was −0.9° (±8.1) and at 6 months follow-up (n = 29) was 0.4° (±2.4), compared to 43.2° (±9.0) and 41.8 (±9.7) at baseline, respectively, showing mean improvements of over 40°. Mean URAM scores improved from 16.3 (±9.6) at baseline to 1.9 (±3.3) at 1 month of follow-up (n = 56) and from 16.9 (±9.8) to 0.8 (±2.8) at 6 months of follow-up (n = 39), showing improvements of over 13 points. Most treatment-related adverse events were mild or moderate in intensity and resolved without intervention within a median of 10 days. An overall cost savings of £104,732 was made in the 56 patient cohort.

The study demonstrated significant clinical efficacy, safety and cost-effectiveness of CHC injections in a subpopulation of patients fulfilling evidenced-based selection criteria. The results show clinically significant improvements and substantial cost savings compared to surgical fasciectomy, thus providing an alternative to surgery for these patients. However, it must be noted that further well-designed studies are needed to endorse our findings, and surgical fasciectomy remains the gold standard for the treatment of patients with severe Dupuytren's contractures involving multiple joints.