A NEW study comparing treatments for Dupuytren’s contracture has revealed that limited fasciectomy is more effective than collagenase injections for improving hand health over a one-year period. Dupuytren’s contracture, a condition that causes hand deformities by thickening the connective tissue under the skin, often requires intervention to restore hand function.
The randomised, controlled trial involved 672 participants, evenly divided between those receiving collagenase injections and those undergoing limited fasciectomy. The primary outcome was measured using the Patient Evaluation Measure–Hand Health Profile (PEM), a tool that evaluates hand health from the patient’s perspective. PEM scores range from 0–100, with higher scores indicating worse outcomes.
At the one-year mark, patients treated with limited fasciectomy had an average PEM score of 11.9, compared to 17.8 for those receiving collagenase injections. The difference in outcomes, 5.9 points, suggests that collagenase injections did not meet the prespecified criteria for being noninferior to limited fasciectomy. Two-year data revealed an even larger gap, with PEM scores favouring the surgical approach by 7.2 points.
Although complications were more common with surgery, with 5.1% of patients experiencing moderate or severe complications compared to 1.8% in the injection group, the surgical approach resulted in fewer cases of recurrent contracture requiring reintervention. Only 3.4% of patients in the surgery group required additional treatment, compared to 14.6% in the injection group.
The findings indicate that while collagenase injections offer a less invasive option, limited fasciectomy provides superior long-term outcomes for patients with Dupuytren’s contracture. The study underscores the need for careful consideration of treatment options based on patient priorities and the severity of their condition.
Reference
Dias J et al. Collagenase Injection versus Limited Fasciectomy for Dupuytren’s Contracture. New Engl J Med. 2024 ;391(16): 1499-510.
