“Collagenase Clostridium Histolyticum for Dupuytren Contracture: Comparing Single and Concurrent Injections.”

Background: The U.S. FDA approved collagenase Clostridium histolyticum (CCH) for treatment of Dupuytren contracture in 2010, and approved CCH for the concurrent treatment of up to two cords in 2014. Although outcomes and adverse events (AEs) have been well described for single injections, comparative data on concurrent injections is lacking. Methods: We reviewed 121 concurrent CCH injections and compared these with 177 single CCH injections over eight years. All injections were performed by a single surgeon, our senior author. A retrospective cohort model was used to compare clinical outcomes and AEs (skin tears, spontaneous cord rupture, tendon rupture, lymphadenopathy, blood blisters, and ecchymosis) between groups. Results: There were no statistical differences between groups in clinical success rate or change in contracture per joint. The rate of skin tears per joint in concurrent injections (27/121, 22.3%) was not statistically different from that of single injections (33/177, 18.6%; p = 0.46), and was consistent with previously reported rates. The rate of skin tears did not change significantly over time in either group. Concurrent CCH injection was not found to influence the incidence of skin tears in a dose-dependent manner (RR 1.20). Patients receiving concurrent injections experienced a higher rate of lymphadenopathy compared to those receiving single injections (57/121, 47% vs. 51/177, 29%; p = 0.001). Conclusion: Our results show that concurrent CCH injections for Dupuytren contracture have a similar safety profile and treatment efficacy when compared to single injections. We did not find a dose-dependent relationship between skin tears and CCH injected. Financial Disclosure Statement: Dr. Friedman is a speaker for Endo Pharmaceuticals, manufacturer of collagenase Clostridium histolyticum. Dr. Cook, Dr. Waughtel, Dr. Andreoni, and Dr. Sakharpe have nothing to disclose. No funding was received for this article. This study was approved by the Cleveland Clinic Foundation institutional review board (FLA 16-085). Presented at: Plastic Surgery the Meeting (ASPS) 2017 in Orlando, Florida. Financial Disclosure Page: Financial Disclosure Statement: Dr. Friedman is a speaker for Endo Pharmaceuticals, manufacturer of collagenase Clostridium histolyticum. Dr. Cook, Dr. Waughtel, Dr. Andreoni, and Dr. Sakharpe have nothing to disclose. No funding was received for this article. Statement of Authorship: Dr. Cook, Dr. Waughtel, Dr. Andreoni, Dr. Sakharpe, and Dr. Friedman contributed equally to the development of this manuscript. Corresponding author: Jonathan Cook, MD, Department of Plastic Surgery, 2950 Cleveland Clinic Boulevard, Weston, FL 33331 USA. cookj11@ccf.org ©2019American Society of Plastic Surgeons

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