The authors report the case of a 65-year-old, right-hand-dominant man who had severe
Dupuytren's disease with multiple cords and flexion
contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated
collagenase injections for treatment.
Collagenase has been shown to be safe and effective in the treatment of Dupuytren's
contractures when administered as a single dose, but the results of multiple
injections over a prolonged period are unknown.
Antibodies to
collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The
antibodies generated as a result of repeated exposure to
collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as
anaphylaxis. The authors present the case of a single patient who experienced continued correction of his
contractures with only minor and self-limited adverse reactions after administration of 12
collagenase doses through 15
injections during a 4-year period. Over time, the
injections continued to be effective at correcting metacarpophalangeal joint
contractures, but less effective at correcting proximal interphalangeal joint
contractures. The patient did eventually require a
fasciectomy, but the safety and modest success of the repeated
collagenase injections shows promise for a less invasive treatment with a better risk profile than open
fasciectomy. Although further studies are needed, repeated administration of
collagenase appears to be safe and modestly effective for severe Dupuytren's
contractures, although a
fasciectomy may ultimately be required in the most severe cases.