PMID- 22540636
OWN - NLM
STAT- MEDLINE
DCOM- 20121213
LR  - 20220408
IS  - 1471-2474 (Electronic)
IS  - 1471-2474 (Linking)
VI  - 13
DP  - 2012 Apr 27
TI  - Multiple concurrent collagenase clostridium histolyticum injections to 
      Dupuytren's cords: an exploratory study.
PG  - 61
LID - 10.1186/1471-2474-13-61 [doi]
AB  - BACKGROUND: Dupuytren's contracture (DC) is a progressive fibroproliferative 
      disorder characterized by development of nodules and collagen cords within the 
      palmar fascia of the hand. Collagenase clostridium histolyticum (CCH) is 
      currently approved in adults with DC for the nonsurgical treatment of a single 
      palpable cord during a 30-day treatment cycle. This open-label pilot study was 
      designed to examine the safety, efficacy, and multiple-dose pharmacokinetics of 
      injecting two cords (affected joints) with multiple doses of CCH concurrently 
      into the same hand in subjects with DC and multiple contractures. METHODS: Twelve 
      subjects with DC were enrolled, each with >/=3 contractures caused by palpable 
      cords. Efficacy assessments were taken 30 days after treatment and adverse events 
      (AEs) were recorded throughout. In the first treatment period, all subjects were 
      injected with a single dose of CCH (0.58 mg) into a single cord. The same 
      subjects entered a second treatment period 30 days later, where two different 
      cords (affected joints) were injected concurrently on the same hand. A finger 
      extension procedure was performed 24 hours after each administration of CCH to 
      disrupt the enzymatically weakened cord. RESULTS: For metacarpophalangeal (MP) 
      joints, mean contracture reduction per joint treated was 29.0 +/- 20.7 degrees 
      following single injection vs 30.3 +/- 10.9 degrees per treated joint following 
      multiple injections. For proximal interphalangeal (PIP) joints, mean reduction in 
      contracture was 30.7 +/- 21.1 and 22.1 +/- 4.9 degrees per treated joint, 
      respectively, for the two periods. All patients (100%) were either "quite 
      satisfied" or "very satisfied" following either treatment cycle. The most common 
      treatment-related AEs were edema peripheral, contusion, and pain in the treated 
      extremity; the differences in severity for local effects of the injections were 
      minimal between treatment periods. No serious treatment-related AEs or systemic 
      complications were reported. CONCLUSION: These results provide preliminary 
      evidence that two cords (affected joints) can be treated concurrently with CCH 
      with similar efficacy and safety as cords treated individually in a sequential 
      fashion. Multiple concurrent injections would eliminate the 30-day wait between 
      single treatments and allow for rapid and effective treatment of patients with 
      multiple affected joints, a significant advantage for both patient and physician. 
      TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry 
      #ACTRN12610001045000.
FAU - Coleman, Stephen
AU  - Coleman S
AD  - Brisbane Hand and Upper Limb Clinic, Brisbane, Queensland, Australia. 
      sgcoleman@optusnet.com.au
FAU - Gilpin, David
AU  - Gilpin D
FAU - Tursi, James
AU  - Tursi J
FAU - Kaufman, Greg
AU  - Kaufman G
FAU - Jones, Nigel
AU  - Jones N
FAU - Cohen, Brian
AU  - Cohen B
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120427
PL  - England
TA  - BMC Musculoskelet Disord
JT  - BMC musculoskeletal disorders
JID - 100968565
RN  - EC 3.4.24.3 (Microbial Collagenase)
SB  - IM
MH  - Age of Onset
MH  - Drug Administration Schedule
MH  - Dupuytren Contracture/diagnosis/*drug therapy/epidemiology/physiopathology
MH  - Female
MH  - Humans
MH  - Injections, Intralesional
MH  - Male
MH  - Microbial Collagenase/*administration & dosage/pharmacokinetics
MH  - Middle Aged
MH  - Pilot Projects
MH  - Queensland/epidemiology
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC3409044
EDAT- 2012/05/01 06:00
MHDA- 2012/12/14 06:00
PMCR- 2012/04/27
CRDT- 2012/05/01 06:00
PHST- 2011/10/12 00:00 [received]
PHST- 2012/04/27 00:00 [accepted]
PHST- 2012/05/01 06:00 [entrez]
PHST- 2012/05/01 06:00 [pubmed]
PHST- 2012/12/14 06:00 [medline]
PHST- 2012/04/27 00:00 [pmc-release]
AID - 1471-2474-13-61 [pii]
AID - 10.1186/1471-2474-13-61 [doi]
PST - epublish
SO  - BMC Musculoskelet Disord. 2012 Apr 27;13:61. doi: 10.1186/1471-2474-13-61.