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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2017; 45(02): 070-088
DOI: 10.1055/s-0037-1608749
Original Article | Artículo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Efficacy of Collagenase Clostridium Histolyticum for Dupuytren Disease: A Systematic Review

Article in several languages: English | español
Rafael Sanjuan-Cerveró
1   Department of Orthopedics and Traumatology Surgery, Hospital de Dénia, Alicante, Spain
,
Pedro Vazquez-Ferreiro
2   Department of Ophthalmology, Hospital Virxe da Xunqueira, La Coruña, Spain
,
Diego Gomez-Herrero
3   Pharmacy Service, Hospital 9 de Octubre, Valencia, Spain
,
Francisco Javier Carrera-Hueso
4   Pharmacy Service, Hospital Dr. Moliner, Valencia, Spain
› Author Affiliations
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Publication History

26 July 2017

19 September 2017

Publication Date:
22 November 2017 (online)

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Abstract

Introduction Collagenase Clostridium Histolyticum (CCH) has become a therapeutic alternative for Dupuytren disease. However, its efficacy in the medium to long term is unknown. The objective of our study is to carry out a systematic review of the studies conducted on the subject.

Material and Methods Systematic bibliographic search. Analysis depending on the time of progression, looking into 2 groups with the follow-up cut-off point of 1 year. Analysis of the number of patients who reached the primary endpoint, of the mean correction in degrees, and of the proportional correction of each joint.

Results The 50 selected clinical trials encompass a total of 4,622 patients (an average of 92.70). A total of 7,546 joints were treated with the mean being 148.15 joints per trial (3,925 metacarpophalangeal [MCP] and 2,350 proximal interphalangeal [PIP]). In less than one year of progression, the primary end point was reached in 48.9% of the joints (69.77% of the MCPs and 30.14% of the PIPs), the mean correction in degrees was 45.5 (standard deviation [SD]: 19.18) degrees; 40.8 degrees in the MCP (SD: 10.12) and 35.6 in the PIP (SD: 13.23), and the proportional correction of the joints was 72.9% (SD: 14.43) (83.9% for MCPs [SD: 12.58] and 64.2 for the PIPs [SD: 16.35]). In the follow-ups over 1 year, the primary end point was reached at a rate of 57.5% (68.9% of the MCPs and 43.3% of the PIPs), the mean correction in degrees was 37.6 degrees (SD: 10.93) (37.3 degrees in the MCPs [SD: 9.98] and 23.7 in the PIPs [SD: 16.33]) and the proportional correction of the joints was 87.3% (SD: 10.96) (90.3% for MCP [SD: 6.94] and 75% for PIP [SD: 13.54]).

Conclusions The results indicate a satisfactory response to CCH treatment maintained in the short and medium term. The recurrence rate is uncertain given the available data.

Keywords

collagenase - clostridium histolyticum - efficacy - systematic review
 

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