Collagenase may be associated with a higher recurrence rate of 14.6% compared with just 3.4% for the surgical option, according to a recent study.
In the multicenter, randomized trial, published in The New England Journal of Medicine, researchers compared the efficacy of collagenase injections with limited fasciectomy in 672 patients with moderate Dupuytren’s contracture. They noted that 336 patients each were randomly assigned to receive either collagenase injections or undergo limited fasciectomy. The primary outcome analysis included 599 patients, comprising 314 from the collagenase group and 285 from the limited fasciectomy group.
The primary outcome was measured using the Patient Evaluation Measure (PEM) score, which ranges from 0 to 100, with higher scores representing poorer outcomes. At 1 year, the mean PEM score was 17.8 in the collagenase group and 11.9 in the limited fasciectomy group, with an estimated difference of 5.9 points (95% confidence interval [CI] = 3.1–8.8), failing to meet the noninferiority margin. At 2 years, the difference in PEM scores increased to 7.2 points (95% CI = 4.2–10.9), favoring limited fasciectomy.
Complications occurred in 1.8% of the patients in the collagenase group and 5.1% of those in the limited fasciectomy group.
The trial had several limitations. It was not blinded, which may have influenced patient-reported outcomes, although joint contracture measurements favored limited fasciectomy. Changes in care during the COVID-19 pandemic impacted treatment and follow-up, with 31% of participants unable to complete 2 years, possibly leaving some recurrences unreported. Long-term follow-up is needed to evaluate contracture progression and reintervention rates. The predominantly White study population may limit generalizability, though Dupuytren's contracture primarily affects those of northern European descent. Despite results favoring limited fasciectomy, some patients may choose collagenase injections to reduce complications and recovery times.
Full disclosures can be found in the published study.