Comparative Effectiveness of Collagenase Injection for Dupuytren Contracture

Fig. 35.1

Patient selection flowchart. CCH clostridium collagenase histolyticum, LF limited fasciectomy, MHQ Michigan Hand Outcomes Questionnaire

Table 35.1 shows the baseline characteristics of the study sample before and after propensity score matching. Before matching, the CCH group, on average, had relatively milder PIP and DIP joint contractures but worse MP joint contractures. Additionally, fewer CCH patients underwent treatment for recurrent disease, and they differed in terms of which fingers were involved. Using propensity scores, we were able to match 66 CCH patients with mean baseline contractures of 39° degrees for 43 affected MP joints and 41° for 43 affected PIP joints to 66 comparable LF patients with mean baseline contractures of 39° degrees for 39 affected MP joints and 41° for 52 affected PIP joints (Table 35.2).

Table 35.1

Baseline characteristics before and after propensity score matching, by treatment group

	All patients			Matched patients
	CCH (N = 104)	LF (N = 114)	P value	CCH (N = 66)	LF (N = 66)	P value
Demographics
Age – years	61 ± 10	63 ± 9	0.410	61 ± 10	63 ± 8	0.334
Male gender – %	80	81	0.868	82	76	0.394
Diabetes – %	3	9	0.087	6	5	0.698
Current tobacco use – %	9	16	0.090	8	15	0.170
Disease characteristics
Recurrent disease – %	26	38	0.063	33	30	0.709
Bilateral disease – %	85	83	0.797	89	89	1.000
Treated side is dominant – %	58	53	0.453	53	61	0.380
Positive family history Dd – %	54	60	0.388	59	49	0.222
Treated finger			0.003			0.789
Little – %	48	72		55	61
Ring – %	37	24		33	32
Other – %	15	4		12	8
Outcomes at baseline
Contracture^a – degrees
MP joint	29 ± 24	19 ± 27	0.002	26 ± 25	23 ± 25	0.632
PIP joint	22 ± 25	44 ± 27	<0.001	27 ± 26	33 ± 25	0.221
DIP joint	1 ± 4	8 ± 14	<0.001	1 ± 14	2 ± 14	0.547
Total MHQ score (0–100)	75 ± 14	74 ± 15	0.844	77 ± 13	75 ± 14	0.545

Plus-minus values are means ± SD

CCH collagenase clostridium histolyticum, LF limited fasciectomy, Dd Dupuytren Disease, MP metacarpophalangeal, PIP proximal interphalangeal, DIP distal interphalangeal, SD standard deviation, MHQ Michigan Hand Outcomes Questionnaire

^aValues are reported for all joints

Table 35.2

Adverse events, by matched treatment groups

Adverse event	CCH (N = 66)	LF (N = 66)
Serious
Tenosynovitis	0 (0)	3 (5)
Nerve injury	0 (0)	1 (2)
Arterial injury	0 (0)	0 (0)
Tendon rupture	0 (0)	0 (0)
Cold intolerance	0 (0)	0 (0)
CRPS	0 (0)	0 (0)
Mild
Peripheral edema	49 (74)	n.a.
Contusion	42 (64)	n.a.
Extensive	3 (5)	n.a.
Mild	39 (59)	n.a.
Pain in extremity	17 (26)	n.a.
Blood blister	9 (14)	n.a.
Skin fissure	5 (8)	0 (0)
Paresthesia	3 (5)	3 (5)
Axillary tenderness	6 (9)	n.a.
Erythema	3 (5)	n.a.
Wound dehiscence	0 (0)	2 (3)
Pruritus	3 (5)	n.a.
Lymphadenopathy	2 (3)	n.a.
Neuropraxia	0 (0)	1 (2)
Flare reaction	1 (2)	0 (0)