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I understand Xiaflex injections for Dupuytren's hasn't been around very long. From what you know that has been reported so far, what are they saying about results after a year or two?
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You are correct that the use of this collagenase enzymatic product known as Xiaflex is a relatively new treatment for Dupuytren's contracture. By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken. Then the patient can stretch the fingers and break apart the cord himself/herself.
Early studies showed a good success rate in reducing contractures affecting the metacarpophalangeal (MCP) joints using this injection treatment. The MCP joints are what we usually refer to as the "knuckles." Almost everyone treated this way has been able to straighten the MCP joints with less than a 30-degree flexion contracture. Results have not been quite as good for the PIP joints. Less than half of the patients with PIP contractures regained full motion of the affected joint.
Some of the first long-term studies have started to release the results of their data analysis. Thirty-seven hand surgeons from around the world have worked together over a period of years to gather information on the long-term results of using collagenase injection for Dupuytren's contracture.
They recently published a report summarizing their findings using recurrence rate as the main measuring stick for success/failure. Of the 1,080 joints treated with collagenase injection, the long-term results (after three to five years) measured by recurrence rates with enzyme fasciotomy were not quite as good as responses in the short-term.
For example, one-third of the MCP joints and two-thirds of the proximal interphalangeal (PIP) joints that were corrected had a recurrence. And of the joints that were only partially corrected in the first study, half had a worsening in the years to follow.
Recurrence was defined as a 20-degree (or more) flexion contracture (finger won't straighten and remains flexed by at least 20-degrees). These are fingers that were able to straighten within five degrees of normal after the injection.
Adverse effects of this injection treatment for Dupuytren's contracture are minimal and in the long-term, nothing worse than recurrence occurs. This was true even when up to eight injections were used and bloodworm showed antibodies in response to the collagenase. No systemic allergic reactions occurred.
The authors concluded that the treatment is safe and effective for mildly involved joints. Their study will continue on and collect further long-term information. The treatment is certainly worth a try if it can prevent patients from having surgery. Results are not as good with PIP joints but repeat injections or even surgery are always follow-up options.
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