Collagenase clostridium histolyticum for Dupuytren’s disease: a comprehensive systematic review and comparative analysis against percutaneous needle aponeurotomy and limited fasciectomy

Jevan Cevik; Rohan Rajaram; Michaela Pollock; Ishith Seth; Warren M. Rozen

doi:10.2340/jphs.v60.42750

Authors

Jevan Cevik Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
Rohan Rajaram Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
Michaela Pollock Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
Ishith Seth Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia
Warren M. Rozen Department of Plastic and Reconstructive Surgery, Peninsula Health, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Victoria, Australia

DOI:

https://doi.org/10.2340/jphs.v60.42750

Keywords:

Dupuytren’s contracture, collagenase clostridium histolyticum, percutaneous needle aponeurotomy, limited fasciectomy

Abstract

This systematic review compared the efficacy of collagenase clostridium histolyticum (CCH) against percutaneous needle aponeurotomy (PNA) and limited fasciectomy (LF) for Dupuytren’s contracture. Searches were conducted in PubMed, Embase, and Web of Science databases to March 2024. Randomised controlled trials (RCTs) were included. Primary outcomes included successful contracture correction as defined by included studies. Secondary outcomes included recurrence rates, patient-reported outcomes, and adverse events. A total of 11 studies (969 patients) were included. Meta-analysis showed no difference in efficacy between CCH and PNA (Relative Risk [RR]: 1.01, 95% Confidence Interval [CI]: 0.93–1.09). Recurrence rates were also similar (RR: 1.18, 95% CI: 0.95–1.48). Data suggested higher recurrence risk with CCH versus LF (RR: 6.84, 95% CI: 1.59–29.48). In some studies, CCH was associated with higher rates of haematoma, local pain, and oedema. CCH demonstrates comparable efficacy to PNA; however, it may have a higher risk of local complications and recurrence compared to LF. Treatment decisions should be made on a case-by-case basis.

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