Late complications of clinical clostridium histolyticum collagenase use in Dupuytren's disease

PLoS One. 2012;7(8):e43406. doi: 10.1371/journal.pone.0043406. Epub 2012 Aug 17.

Abstract

Introduction: While Dupuytren's disease can cause disabling contractures requiring open surgery, a less-invasive option using Clostridium Histolyticum collagenase (CHC) via percutaneous injection was recently reported. A recent prospective, randomized trial demonstrated few complications during 90 days follow-up, however did not assess any longer term follow-up for these patients. Long-term outcomes in this setting have not been adequately reported, and the current manuscript aims to identify late complications from the clinical use of percutaneous CHC.

Methods: The current manuscript reports an extended 12-month follow-up for a cohort of twelve of patients enrolled in the original prospective, randomized trial, treated at a single institution. An analysis of complications requiring surgical intervention was undertaken.

Results: Two of twelve patients reported debilitating pain and triggering requiring surgical intervention. Extensive deep-tissue scarring and adhesions were identified, providing the first visual and qualitative analysis of the pathologic effects of CHC.

Conclusion: Late complications from CHC use can and have occurred, outside the follow-up period of the initial phase III trials. Longer term follow-up of such patients is thus essential, and further investigation and characterization of the late effects of CHC use is warranted.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Retracted Publication

MeSH terms

  • Cicatrix
  • Clostridium histolyticum / enzymology
  • Cohort Studies
  • Dupuytren Contracture / drug therapy*
  • Dupuytren Contracture / pathology
  • Dupuytren Contracture / surgery
  • Follow-Up Studies
  • Hand Deformities, Acquired / drug therapy*
  • Hand Deformities, Acquired / pathology
  • Hand Deformities, Acquired / surgery
  • Humans
  • Male
  • Microbial Collagenase / adverse effects*
  • Microbial Collagenase / therapeutic use
  • Pain
  • Tissue Adhesions / etiology
  • Tissue Adhesions / surgery

Substances

  • Microbial Collagenase

Grants and funding

The authors have no support or funding to report.