Poster Presentation #21 American Society for Surgery of the Hand
Las Vegas, September, 2011
Variation in Strategies to Achieve Successful Cord Release Following Collagenase Clostridium Histolyticum Injection for Dupuytren’s Contracture
Keith A. Denkler, MD;Eric N. Britton, MD;Joel L. Frazier, MD Joseph E. Kutz, MD Robert N. Hotchkiss, MD ;Paul Skodny, PharmD
HYPOTHESIS The collagenase clostridium histolyticum (CCH, XIAFLEX) registration trial (CORD1) did not include the use of local anesthesia in the standard protocol finger extension procedure. We hypothesized that in clinical practice local anesthesia would be used, and would have a positive effect on the cord release rate.
METHODS 10 practice sites in the US collected 12 months treatment data by retrospective chart review. The extension process and outcomes were summarized in a table abstracted for all CCH treatments. RESULTS The first post injection visit data in 281 CCH treated patients with complete records were included in the analysis. 260(92.5%) of the extensions employed local anesthetic. In 179(63%), a full release (0-5 ) was achieved; 95(34%), a partial release; and 8(2.8%), no release. The full release rates in MP and PIP joints were 132/181(73%) and 46/100(46%) respectively (Chi-square, p=50% reduction in contracture) without full release was obtained in an additional 28.6% (n=203).
SUMMARY POINTS In clinical practice, 97.2% of extension visits resulted in a release after the first injection (63% full, 34% partial). Full release rate after first injection was higher in clinical practice (63%) compared to a randomized trial (39%), likely related to the use of local anesthesia.
REFERENCE Hurst LC, Bedalamente MA, Hentz VR, Hotchkiss RA, Kaplan TD, et al. Injectable Collagenase Clostridium Histolyticum for Dupuytren s Contracture. NEJM 2009;361:968-979.
Table 1.Comparison of frequency achieving full cord release after first collagenaseclostridium histolyticuminjection between two cohorts from 2 different study designs. Retrospective Chart Review Study (2010)
Prospective CORD 1 Trial (published 2009)1
Full cord release 181* (63%) 79 ** (39%)
Partial cord release 105 (37%) 124 (61%)
Total 286 (100%) 203 (100%)
chi-square = 28.3, degrees of freedom = 1, probability < 0.0001