Treatment Options for Dupuytren’s Contracture Save
The NEJM reports that in a randomized, controlled, head to head trial, collagenase injections were non-inferior to limited fasciectomy in the treatment of Dupuytren’s contracture.
An unblinded, multicenter, noninferiority trial compared collagenase injection to limited fasciectomy in 599 patients with moderate Dupuytren’s contracture. The primary outcome was the score on the Patient Evaluation Measure–Hand Health Profile (PEM), a questionnaire for assessing hand health. The prespecified noninferiority margin was 6 points.
A total of 599 patients were randomized: 314 in the collagenase group and 285 in the limited-fasciectomy group. The mean PEM score (outcome) at 1 year was:
- collagenase - 17.8
- limited-fasciectomy - 11.9 (estimated difference, 5.9 points; 95% confidence interval [CI], 3.1 to 8.8; one-sided P=0.49 for noninferiority).
Fewer complications (1.8%) were seen in the collagenase group vs. the limited-fasciectomy group (5.1%). Reintervention was necessary more with collagenase (14.6% and 3.4%, respectively).
Collagenase injection was not noninferior to limited fasciectomy after 1 year of treatment.
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