Enzyme injection (collagenase) to treat Dupuytren's contracture
This is the most recent additionn to Dupuytren's therapies. Dupuytren's contracture is characterized by excessive collagen deposition which appears as cords causing an extension deficit, i.e. a bent finger. These finger cords causing metacarpophalangeal and/or proximal interphalangeal joint contracture (contracture at the base or middle joint of a finger) are targeted by a non-operative method injecting an enzyme (Clostridial collagenase, brand name: Xiaflex). This enzyme weakens the cord which then, in a next step, can be pulled and mechanically broken. Bent fingers thus become straight and functional again. One of the early studies proposes enzyme injection as a safe and effective method of treating as an alternative to surgical fasciectomy: "In fact some of our patients who have had fasciectomy on one hand but have been treated in our trials for the contralateral hand have commented in glowing terms that the less invasive injection treatment was far superior to their surgical experience. … To date our recurrence rates are low in the clinical trials described and are < 5% at 4 years from our first open-label clinical trial using 10,000 U of collagenase. There have been no disease extensions to other fingers." Link:abstract_enzyme_article, full text see literature.
There is already good and longer term evidence of the therapy's effectiveness. Phase 3 of clinical trials has been completed and Xiaflex was approved by the US FDA in February 2010 for treating Dupuytren's contracture.
Patients' experience
If you are interested in experience of patients with collagenase injections please visit our forum, e.g. the threads "Auxilium AA4500 Phase 3 Clinical Trial Experience" and "Auxilium AA4500 Trials Report" and "Xiaflex approved by FDA today". For a while collagenase had been provided under the brand name AA4500. The current brand name used by its manufacturer Auxilium is Xiaflex.
Video of collagenase treatment
Below are several YouToube links from a patient who documented various phases prior, during, and after her collagenase treatment. It does not show much of the procedure itself but shows results and related feelings.
A more advertizing video, also showing Drs. Maria Badalamente and Lawrence Hurst, the inventors of the collagenase treatment, is on
http://video.aol.de/video-detail/frozen-finger-fix/446064678
Collagenase and NA - what is the difference?
The treatment of Dupuytren's contracture with collagenase injection is similar to needle aponeurotomy (also called NA or needle fasciotomy). Both treatments address already bent fingers and both start with weakening the contracting cord. NA does this by stitching a thin needle several times into the cord and thus weaking it mechanically. Collagenase does this weakening by injecting a small amount of collagenase, which locally weakens/dissolves a small fracture of the cord. After this weaking step both therapies stretch the finger mechanically until the weakened cord actually snaps and the finger becomes straight again. The difference between collagenase and NA is essentially the way by which the cord is weakened before it is broken mechanically. Injection of collagenase is therefore sometimes also described as enzyme fasciotomy.
Collagenase for Ledderhose disease and Peyronie's disease
Collagenase is not yet tested for treatment of Ledderhose disease, maybe due to smaller market opportunities or maybe due to dominating nodules rather than cords. - Collagenase has been proposed as therapy for Peyronie's disease and is currently in a phase IIb trial to get approval auxilium_press_release.
Page last modified: 05/14/2010