A clinical trial by British scientists has shown that collagenase injections are no worse than fascia dissection in helping restore movement in patients with Dupuytren's contracture. As reported in The New England Journal of Medicine, the difference in the degree of preservation of hand function in the two treatment groups was statistically insignificant.
Dupuytren's contracture is a symptom of Dupuytren's disease, in which fibrous bands form in the hand, which shorten over time and lead to constant bending of one or more fingers, limiting extension. Such changes worsen the quality of life, and surgical treatment of contracture often leads to relapse. Another method of treating contracture that is gaining popularity is the introduction of collagenase, an enzyme that destroys collagen, into the fibrous bands. However, there is practically no comparison of the effectiveness of these two methods in the literature.
A team led by Joseph Dias from the University Hospitals of Leicester assessed the efficacy and safety of collagenase injection compared with limited fascial incision (band) in the treatment of moderate Dupuytren's contracture. Six hundred and seventy-two patients were randomly divided equally into two groups: one group received three collagenase injections followed by contracture breakdown, while the other group received surgical removal of the affected ligaments to correct the contracture.
One year after treatment, the mean score on the questionnaire characterizing the health of the hands and quality of life (the higher the score, the worse the health of the hands) was 17.8 in the collagenase treatment group and 11.9 in the surgery group. The analysis showed that collagenase was no less effective than fascia incision (p = 0.49). These results were maintained at two years. Similar conclusions were made when measuring the preservation of hand function using other questionnaires and scales. The difference in the risk of recurrence was also statistically insignificant.
Doctors conclude that collagenase injections may be as effective and safer than surgery for Dupuytren's contracture. Moderate or severe complications were rare, but they were more common in the surgery group than in the collagenase group.
However, it is possible to reduce the risk of surgery in quite accessible ways. Recently we reported that 7.5 thousand steps a day for a month before surgery reduced the likelihood of complications after it.
